Abstract

Introduction: Functional dyspepsia (FD) and non-erosive reflux disease (NERD) are prevalent gastrointestinal conditions with accumulating evidence on overlap between the two. Still, NERD is a very heterogeneous group of patients and limited data on dyspeptic symptoms in various subgroups of NERD is available.

Aim: To evaluate prevalence of dyspeptic symptoms in patients with NERD subclassified using 24-hour impedance-pH monitoring (MII-pH).

Methods: Patients with typical reflux symptoms and normal endoscopy underwent impedance-pH monitoring off PPI therapy. Oesophageal acid exposure time (AET), type of acid and non-acid reflux episodes, symptom association probability (SAP) were calculated. A validated Dyspepsia Questionnaire was used to quantify dyspeptic symptoms prior to reflux monitoring.

Results: Out of 200 NERD patients (105F, median age 48 yrs), 81 (41%) had an abnormal oesophageal AET (NERD pH-POS), 65 (32%) normal oesophageal AET and positive SAP for acid and/or non-acid reflux (hypersensitive oesophagus) and 54 (27%) normal oesophageal AET and negative SAP (functional heartburn). Patients with functional heartburn had more frequent (p<0.01) postprandial fullness, bloating, early satiety and nausea compared to patients with NERD pH-POS and hypersensitive oesophagus.

Conclusion: The increased prevalence of dyspeptic symptoms in patients with functional heartburn reinforces the concept that functional gastrointestinal disorders extend beyond the boundaries suggested by the anatomical location of symptoms. This should be regarded as a further argument to test patients with GORD symptoms in order to separate patients with functional heartburn from NERD patients in whom symptoms are associated with gastro-oesophageal reflux.