Overlap of Gastroesophageal Reflux Disease and Functional Dyspepsia and Yield of Esophagogastroduodenoscopy in Patients Clinically Fulfilling the Rome IV Criteria for Functional Dyspepsia

Abstract

AimTo assess (1) the overlap rate of gastroesophageal reflux disease (GERD) and functional dyspepsia (FD) and (2) the yield of esophagogastroduodenoscopy in patients clinically presenting with FD.Materials and MethodsOutpatients aged ≥18 years with typical reflux symptoms ≥2 times a week or clinically fulfilling the Rome IV criteria for FD were recruited and underwent esophagogastroduodenoscopy. GERD was classified into non-erosive reflux disease (NERD) and erosive reflux disease (ERD), and FD was classified into epigastric pain syndrome and postprandial distress syndrome. The endoscopic findings that could explain patients’ symptoms were considered clinically significant endoscopic findings. After esophagogastroduodenoscopy, patients were categorized into three groups: GERD-only, FD-only, and GERD-FD overlap.ResultsThere were 439 patients with a mean age of 42.3 ± 11.6 years. Ninety-one (20.7%) patients had clinically significant endoscopic findings: 73 (16.6%) reflux esophagitis, 6 (1.4%) Barrett’s esophagus and 14 (3.2%) gastroduodenal ulcers. After excluding gastroduodenal ulcers, the numbers of patients with GERD-only, FD-only, and GERD-FD overlap were 69 (16.2%), 138 (32.5%), and 218 (51.3%), respectively. Postprandial distress syndrome was more prevalent in GERD-FD overlap than in FD-only (72.9 vs. 44.2%, p < 0.001). The rates of gastroduodenal ulcers in patients clinically fulfilling the criteria for FD with and without reflux symptoms were 0.6 and 4.7%, respectively (p = 0.027).ConclusionThe GERD-FD overlap was more common than each disorder alone, of which postprandial distress syndrome was significantly prominent. Organic dyspepsia was uncommon in patients clinically fulfilling the Rome IV criteria for FD.

Characteristics and Risk Factors of Functional Dyspepsia Fulfilling the Rome IV Criteria Overlapping With Gastroesophageal Reflux Disease, Irritable Bowel Syndrome, and Functional Constipation in South China

“…A study from United States reported no significant differences in age or gender among patients with GERD-FD overlap, GERD only, and dyspepsia only. 43 However, study from Vietnam indicated that older age were predominant in GERD-FD overlap, no gender and BMI difference was found, 11 female predominance were noted in FGIDs overlap patients in a study from South Korea. 44 A recent study indicated that waist-to-hip ratio but not BMI was a risk factor for GERD in Vietnamese patients.…”

“… 9 Although there are separate guidelines for managing each disorder, FD-GERD overlap is very common by shared pathophysiology, including delayed gastric emptying and impaired gastric accommodation. 10 , 11 A meta-analysis review showed that 7.41% overlap between FD and GERD in the general population, and 31.32% FD with GERD symptoms. 10 Studies from Asia showed the prevalence of FD-GERD overlap is about 20.00-80.00% in different countries and regions.…”

The Efficacy of Dietary Interventions in Patients with Gastroesophageal Reflux Disease: A Systematic Review and Meta-Analysis of Intervention Studies

“…However, the two studies included patients with either GERD or FD, with a primary focus on patients with FD. Though GERD and FD commonly overlap, they are different diseases and contain different pathophysiological etiologies [45,46]. Two studies on low-carbohydrate diets and one study on a low-FODMAP diet were included in the previous study, and these have also been included in our study.…”

Role and safety of prokinetic drugs in the treatment of upper gastrointestinal motility disorders: an Indian perspective

“…10 A study by Quach et al showed that FD-PDS is more prevalent among patients with FD-GERD overlap and NERD-FD overlap, causing more severe symptoms. 21 First-line treatment for GERD patients are acid-suppressive treatments such as PPIs or histamine H2-antagonists in conjunction with dietary and lifestyle modifications. Despite this, a considerable proportion of patients with some types of GERD do not experience symptomatic relief.…”