Overdiagnosis of gastro‐esophageal reflux disease and underdiagnosis of functional dyspepsia in a USA community

Abstract

We have found evidence supporting a systematic bias away from diagnosing FD, favoring a GERD diagnosis.

The role of diet in the overlap between gastroesophageal reflux disease and functional dyspepsia

“…The difficulty in differentiating between dyspepsia and GERD symptoms was also reported; a recent paper revealed an over-diagnosis of GERD and under-diagnosis of functional dyspepsia in a US community. Actually, only 62.9% of subjects reporting GERD symptoms were correctly diagnosed with GERD, and only 12.5% of subjects reporting dyspepsia were correctly diagnosed (10). In our unpublished data, looking for recent symptoms, we found that heartburn (epigastric pain) was frequently present in both diseases, and this suggests the same idea and explains the overlap.…”

“…In current practice, an over-diagnosis of GERD and under-diagnosis of functional dyspepsia was reported (10).…”

Functional Dyspepsia

“…14 In the past 20 years, there has been a concerted effort to standardize the definitions of functional dyspepsia, in part to minimize the likelihood of overlap with other functional gastrointestinal disorders. For the most part, this goal has been achieved by excluding from the definition of functional dyspepsia persons with symptoms suggestive of gastroesophageal reflux disease (GERD), such as retrosternal burning pain, regurgitation of acid into the mouth, or the irritable bowel syndrome, which is characterized by lower abdominal pain or discomfort associated with a change in stool form or frequency.…”

“First Do No Harm”: Adverse Events from Pharmaceutical Treatment of Gastroparesis and Dyspepsia

“…The authors identified 1245 and 21,243 reports listing gastroparesis or dyspepsia, respectively; the demographics of these reports mirrored published epidemiologic factors with a female predominance and mean age in the sixth decade [1,8]. It is unclear whether FAERS reports associated with treatment of dyspepsia refer to the syndrome of functional dyspepsia or with isolated dyspepsia, a symptom commonly accompanying gastroesophageal reflux disease [1,3]. This distinction remains important globally since treatment of functional dyspepsia can include the use of the few prokinetic agents available for functional dyspepsia, including, metoclopramide, a drug that is not generally recommended [12].…”

“…Often misdiagnosed as GERD and treated with proton pump inhibitors (PPIs) with modest to no benefit [3], functional dyspepsia is common, with a prevalence of 5-11% [1]. Functional dyspepsia according to the Rome IV diagnostic criteria [4] comprises postprandial distress syndrome (bothersome postprandial fullness or early satiety severe enough to impact on regular activities for 3 or more days per week in the past 3 months) or the epigastric pain syndrome (bothersome epigastric pain or epigastric burning 1 or more days per week in the past 3 months), although many patients complain of both syndromes [4].…”