Overlap of Erosive and Non-erosive Reflux Diseases With Functional Gastrointestinal Disorders According to Rome III Criteria

Abstract

Background/aims: Gastroesophageal reflux disease (GERD) is increasing in Asian countries. Functional dyspepsia (FD) or irritable bowel syndrome (IBS) are also prevalent and commonly overlapped with GERD. This study was conducted to compare the proportion and risk factors for overlapping reflux esophagitis (RE) and non-erosive reflux disease (NERD) with functional gastrointestinal disorders (FGIDs).

Methods: A total of 2,388 [male, 55.9%; mean age (+/- SD), 43.2 years (+/- 8.4)] Korean subjects who underwent the upper endoscopy for health screening were prospectively included. The subjects were asked about demographic, medical and social history by using a structured questionnaire, and FD and IBS were assessed according to the Rome III criteria.

Results: The subjects with RE were 286 (12.0%, male 88.5%, 42.8 years) and 74 subjects had NERD (3.1%) while the prevalence of FD and IBS were 8.1% and 10.1%, respectively. The proportion of FD and IBS in NERD was higher than that of RE (74.3% vs. 10.5%, p = 0.000; 41.9% vs. 11.2%, p = 0.000, respectively). The epigastric pain syndrome (EPS) was more prevalent than postprandial distress syndrome in NERD. According to multiple regression analysis, high somatization score and the presence of FD increased the odd ratio for NERD. However, male gender and current smoker were significant risk factors for RE.

Conclusions: Compared to RE, NERD is more frequently overlapped with FD, especially EPS, and also are associated with significantly increased frequency of IBS. Our data draws attention to the possibility of subgrouping FGIDs and GERD to be important in understanding the pathophysiology of these conditions.

Keywords: Dyspepsia; Functional gastrointestinal disorders; Gastroesophageal reflux; Irritable bowel syndromes.

Figure 1

The proportion of functional dyspepsia (FD) and its subtypes are compared among reflux esophagitis (RE), non-erosive reflux disease (NERD), and the reference group. ^*RE vs. NERD, ^**NERD vs. Reference. EPS, epigastric pain syndrome; PDS, postprandial distress syndrome.

Figure 2

The proportion of irritable bowel syndrome (IBS) and its subtypes are compared among reflux esophagitis (RE), non-erosive reflux disease (NERD), and the reference group. ^*RE vs. NERD, ^**NERD vs. Reference. IBS-C, constipation-predominant IBS; IBS-D, diarrhea-predominant IBS; IBS-M, mixed pattern of IBS; IBS-U, unclassified pattern of IBS.