Gastroesophageal reflux disease, functional dyspepsia and irritable bowel syndrome: common overlapping gastrointestinal disorders

Abstract

Several studies have indicated an overlap between gastroesophageal reflux disease (GERD) and various functional gastrointestinal disorders (FGIDs). The overlapping conditions reported have mainly been functional dyspepsia (FD) and irritable bowel syndrome (IBS). The available literature is frequently based on symptomatic questionnaires or endoscopic procedures to diagnose GERD. Rarely, among patients with heartburn, pathophysiological evaluations have been considered to differentiate those with proven GERD from those without. Moreover, both GERD and IBS or FD showed enormous heterogeneity in terms of the criteria and diagnostic procedures used. The GERD-IBS overlap ranges from 3-79% in questionnaire-based studies and from 10-74% when GERD has been diagnosed endoscopically. The prevalence of functional dyspepsia (after normal upper endoscopy) is 12-15% and an overlap with GERD has been reported frequently. Only a few studies have considered a potential overlap between functional heartburn (FH) and IBS using a 24-h pH-metry or impedance-pH evaluation. Similar data has been reported for an overlap between FH and FD. Recently, a revision of the Rome criteria for esophageal FGIDs identified both FH and hypersensitive esophagus (HE) as potential functional esophageal disorders. This might increase the potential overlap between different FGIDs, with FH and HE rather than with GERD. The aim of the present review article was to appraise and discuss the current evidence supporting the possible concomitance of GERD with IBS and FD in the same patients and to evaluate how various GERD treatments could impact on the quality of life of these patients.

Does Irritable Bowel Syndrome Exist? Identifiable and Treatable Causes of Associated Symptoms Suggest It May Not

“…Overlap between these conditions is very common, yet pathophysiological reasons for their co-occurrence in the same patient are not well understood [219]. A better understanding of the pathophysiological origin of functional gastrointestinal symptoms related to IBS, GERD and FD may help improve treatment options [220]. In support of this hypothesis, there is empirical evidence to suggest that identification and treatment of a shared pathophysiological origin, H. pylori infection, may resolve overlapping symptoms of IBS, GERD, FD and/or erosive esophagitis in some cases [221].…”

Gastroesophageal reflux disease, irritable bowel syndrome and functional dyspepsia as overlapping conditions: focus on effect of trimebutine

“…In this regard, our own preliminary data [2], also mentioned by the authors [1], showed that H. pylori is common in patients with GERD-IBS-FD and/or erosive esophagitis, while H. pylori eradication plus PPI and/or trimebutine regimens offer improvement in HR-QOL, mainly in patients who receive trimebutine. In a subsequent study, we confirmed our preliminary data [6], signifying the effectiveness of trimebutine in these overlapping populations.…”

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In their comprehensive review, de Bortoli et al [1] aimed to discuss the coexistence of gastroesophageal reflux disease (GERD) with irritable bowel syndrome (IBS) and functional dyspepsia (FD) in the same patients and to evaluate the impact of diverse GERD treatments on the health-related quality of life (HR-QOL) of these patients; they mentioned 2 trials that reported resolution of the IBS symptoms in 20-40% of patients after proton pump inhibitor (PPI) therapy [1]. In one of these trials, we mainly observed [2] that trimebutine maleate is effective in the aforementioned overlapping disorders.Relative data indicate that the prevalence of overlaps of FD and/or IBS in GERD, GERD and/or IBS in FD, and GERD and/or FD in IBS is 46.9%, 47.6% and 34.4%, respectively, with worsened HR-QOL [3].

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Critical evaluation of animal models of visceral pain for therapeutics development: A focus on irritable bowel syndrome

“…Despite its prevalence, visceral pain is often clinically challenging to delineate its etiology based on symptoms and clinical evaluation alone. Visceral pain is a presenting feature of both organic origin and disorders of gut‐brain interaction, although there is frequent overlap between the two . Organic disorders, where histologically definable pathology is associated with visceral pain include cancer, infectious processes, nephrolithiasis, ischemic disorders, gastro‐esophageal reflux disease, peptic ulceration, cholecystitis, pancreatitis, inflammatory bowel disease (IBD), and viscus perforation.…”

“…Visceral pain is a presenting feature of both organic origin and disorders of gut-brain interaction, although there is frequent overlap between the two. 5,6 Organic disorders, where histologically definable pathology is associated with visceral pain include cancer, infectious processes, nephrolithiasis, ischemic disorders, gastro-esophageal reflux disease, peptic ulceration, cholecystitis, pancreatitis, inflammatory bowel disease (IBD), and viscus perforation. However, chronic visceral pain also frequently occurs in the absence of distinct pathology such as in the highly prevalent "nociplastic" conditions of irritable bowel syndrome (IBS) and functional dyspepsia.…”