Digestive Diseases and Sciences

, Volume 64, Issue 2, pp 480–486 | Cite as

Overlap of Irritable Bowel Syndrome and Functional Dyspepsia in the Clinical Setting: Prevalence and Risk Factors

  • Moritz von Wulffen
  • Nicholas J. Talley
  • Johann Hammer
  • Jessica McMaster
  • Graeme Rich
  • Ayesha Shah
  • Natasha Koloski
  • Bradley J. Kendall
  • Mike Jones
  • Gerald HoltmannEmail author
Original Article



According to Rome IV criteria, functional dyspepsia (FD) and irritable bowel syndrome (IBS) are distinct functional gastrointestinal disorders (FGID); however, overlap of these conditions is common in population-based studies, but clinical data are lacking.


To determine the overlap of FD and IBS in the clinical setting and define risk factors for the overlap of FD/IBS.


A total of 1127 consecutive gastroenterology outpatients of a tertiary center were recruited and symptoms assessed with a standardized validated questionnaire. Patients without evidence for structural or biochemical abnormalities as a cause of symptoms were then categorized based upon the symptom pattern as having FD, IBS or FD/IBS overlap. Additionally, this categorization was compared with the clinical diagnosis documented in the integrated electronic medical records system.


A total of 120 patients had a clinical diagnosis of a FGID. Based upon standardized assessment with a questionnaire, 64% of patients had FD/IBS overlap as compared to 23% based upon the routine clinical documentation. In patients with severe IBS or FD symptoms (defined as symptoms affecting quality of life), the likelihood of FD/IBS overlap was substantially increased (OR = 3.1; 95%CI 1.9–5.0) and (OR = 9.0; 95%CI 3.5–22.7), respectively. Thus, symptom severity for IBS- or FD symptoms were significantly higher for patients with FD/IBS overlap as compared to patients with FD or IBS alone (p all < 0.01). Age, gender and IBS-subtype were not associated with overlap.


In the clinical setting, overlap of FD and IBS is the norm rather than the exception. FD/IBS overlap is associated with a more severe manifestation of a FGID.


Functional gastrointestinal disorders Functional dyspepsia Irritable bowel syndrome Symptom severity 



The authors would like to thank all consultants, fellows, nurses and administrative staff of the Department of Gastroenterology and Hepatology of the Princess Alexandra Hospital for their contributions to the clinical assessment and treatment of the patients. Special thanks to Jenny Scott and Elizabeth Debowski for their administrative support.

Author’s contribution

MvW and GH were involved in planning and conducting the study, data collection, analyzing and interpretation of data, drafting of manuscript, and final review of manuscript. JH contributed to the concept and design, data collection, important intellectual input, and critical review of manuscript. MJ was involved in data analysis and critical review of the manuscript. JM, GR, AS, NK, BK and NT contributed to important intellectual input, important contribution to study planning, and critical review of manuscript.


This work was supported by an unrestricted Grant from Diamantina Health Partners in Brisbane, Australia, funding from the PAH Foundation and the National Health and Medical Research Council (NHMRC).

Compliance with ethical standards

Conflict of interest



  1. 1.
    Rome Foundation. Guidelines–Rome III diagnostic criteria for functional gastrointestinal disorders. J Gastrointestin Liver Dis. 2006;15:307–12.Google Scholar
  2. 2.
    Keely S, Walker MM, Marks E, et al. Immune dysregulation in the functional gastrointestinal disorders. Eur J Clin Invest. 2015;45:1350–1359.CrossRefGoogle Scholar
  3. 3.
    Drossman DA, Li Z, Andruzzi E, et al. U.S. householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact. Dig Dis Sci. 1993;38:1569–1580. Scholar
  4. 4.
    El-Serag HB, Talley NJ. Systemic review: the prevalence and clinical course of functional dyspepsia. Aliment Pharmacol Ther. 2004;19:643–654.CrossRefGoogle Scholar
  5. 5.
    Chey WD, Kurlander J, Eswaran S. Irritable bowel syndrome: a clinical review. JAMA. 2015;313:949–958.CrossRefGoogle Scholar
  6. 6.
    Talley NJ. Scope of the problem of functional digestive disorders. Eur J Surg Suppl. 1998;164(S12):35–41.Google Scholar
  7. 7.
    Icks A, Haastert B, Enck P, et al. Prevalence of functional bowel disorders and related health care seeking: a population-based study. Z Gastroenterol. 2002;40:177–183.CrossRefGoogle Scholar
  8. 8.
    Chang L. Review article: epidemiology and quality of life in functional gastrointestinal disorders. Aliment Pharmacol Ther. 2004;20:31–39.CrossRefGoogle Scholar
  9. 9.
    Koloski NA, Talley NJ, Boyce PM. Epidemiology and health care seeking in the functional GI disorders: a population-based study. Am J Gastroenterol. 2002;97:2290–2299.CrossRefGoogle Scholar
  10. 10.
    Camilleri M, Lasch K, Zhou W. Irritable bowel syndrome: methods, mechanisms, and pathophysiology. The confluence of increased permeability, inflammation, and pain in irritable bowel syndrome. Am J Physiol Gastrointestin Liver Physiol. 2012;303:G775–G785.CrossRefGoogle Scholar
  11. 11.
    Vanheel H, Vicario M, Vanuytsel T, et al. Impaired duodenal mucosal integrity and low-grade inflammation in functional dyspepsia. Gut. 2014;63:262–271.CrossRefGoogle Scholar
  12. 12.
    Talley NJ, Ford AC. Functional dyspepsia. N Engl J Med. 2015;373:1853–1863.CrossRefGoogle Scholar
  13. 13.
    Gwee KA, Chua AS. Functional dyspepsia and irritable bowel syndrome, are they different entities and does it matter? World J Gastroenterol. 2006;12:2708–2712.CrossRefGoogle Scholar
  14. 14.
    Owens DM, Nelson DK, Talley NJ. The irritable bowel syndrome: long-term prognosis and the physician-patient interaction. Ann Intern Med. 1995;122:107–112.CrossRefGoogle Scholar
  15. 15.
    Gralnek IM, Hays RD, Kilbourne A, et al. The impact of irritable bowel syndrome on health-related quality of life. Gastroenterology. 2000;119:654–660.CrossRefGoogle Scholar
  16. 16.
    Wang YT, Lim HY, Tai D, et al. The impact of irritable bowel syndrome on health-related quality of life: a Singapore perspective. BMC Gastroenterol. 2012;12:104.CrossRefGoogle Scholar
  17. 17.
    Amouretti M, Le Pen C, Gaudin AF, et al. Impact of irritable bowel syndrome (IBS) on health-related quality of life (HRQOL). Gastroenterol Clin Biol. 2006;30:241–246.CrossRefGoogle Scholar
  18. 18.
    Koloski NA, Talley NJ, Boyce PM. The impact of functional gastrointestinal disorders on quality of life. Am J Gastroenterol. 2000;95:67–71.CrossRefGoogle Scholar
  19. 19.
    Drossman DA, Patrick DL, Whitehead WE, et al. Further validation of the IBS-QOL: a disease-specific quality-of-life questionnaire. Am J Gastroenterol. 2000;95:999–1007.CrossRefGoogle Scholar
  20. 20.
    Ware JE Jr, Gandek B. Overview of the SF-36 Health Survey and the International Quality of Life Assessment (IQOLA) Project. J Clin Epidemiol. 1998;51:903–912.CrossRefGoogle Scholar
  21. 21.
    Rey E, Garcia-Alonso MO, Moreno-Ortega M, et al. Determinants of quality of life in irritable bowel syndrome. J Clin Gastroenterol. 2008;42:1003–1009.CrossRefGoogle Scholar
  22. 22.
    Holz H, Koloski NA, Jones MP, et al. Su1015 the validity of a new Structured Assessment of Gastrointestinal Symptoms Scale (SAGIS) for use in the clinical setting. Gastroenterology. 2016;150:444.CrossRefGoogle Scholar
  23. 23.
    Koloski NA, Jones M, Hammer J, et al. The validity of a new Structured Assessment of Gastrointestinal Symptoms Scale (SAGIS) for evaluating symptoms in the clinical setting. Dig Dis Sci. 2017;62:1913–1922. Scholar
  24. 24.
    Layer P, Andresen V, Pehl C, et al. Irritable bowel syndrome: German consensus guidelines on definition, pathophysiology and management. Z Gastroenterol. 2011;49:237–293.CrossRefGoogle Scholar
  25. 25.
    Drossman DA. Functional gastrointestinal disorders: history, pathophysiology, clinical features and Rome IV. Gastroenterology. 2016;150:1262–1279.CrossRefGoogle Scholar
  26. 26.
    Stanghellini V, Chan FK, Hasler WL, et al. Gastroduodenal disorders. Gastroenterology. 2016;150:1380–1392.CrossRefGoogle Scholar
  27. 27.
    Whitehead WE, Gibbs NA, Li Z, et al. Is functional dyspepsia just a subset of the irritable bowel syndrome? Baillieres Clin Gastroenterol. 1998;12:443–461.CrossRefGoogle Scholar
  28. 28.
    Corsetti M, Caenepeel P, Fischler B, et al. Impact of coexisting irritable bowel syndrome on symptoms and pathophysiological mechanisms in functional dyspepsia. Am J Gastroenterol. 2004;99:1152–1159.CrossRefGoogle Scholar
  29. 29.
    Hammer J, Talley NJ. Disturbed bowel habits in patients with non-ulcer dyspepsia. Aliment Pharmacol Ther. 2006;24:405–410.CrossRefGoogle Scholar
  30. 30.
    Aziz I, Palsson OS, Törnblom H, et al. The prevalence and impact of overlapping Rome IV-diagnosed functional gastrointestinal disorders on somatization, quality of life, and healthcare utilization: a crosssectional general population study in three countries. Am J Gastroenterol. 2018;113(1):86.CrossRefGoogle Scholar
  31. 31.
    Lovell RM, Ford AC. Prevalence of gastro-esophageal reflux-type symptoms in individuals with irritable bowel syndrome in the community: a meta-analysis. Am J Gastroenterol. 2012;107:1793–1801. (quiz 1802).CrossRefGoogle Scholar
  32. 32.
    Irvine EJ, Tack J, Crowell MD, et al. Design of treatment trials for functional gastrointestinal disorders. Gastroenterology. 2016;150:1469–1480.e1.CrossRefGoogle Scholar
  33. 33.
    Frank L, Kleinman L, Rentz A, et al. Health-related quality of life associated with irritable bowel syndrome: comparison with other chronic diseases. Clin Ther. 2002;24:675–689. (discussion 674).CrossRefGoogle Scholar
  34. 34.
    Varni JW, Bendo CB, Nurko S, et al. Health-related quality of life in pediatric patients with functional and organic gastrointestinal diseases. J Pediatr. 2015;166:85–90.CrossRefGoogle Scholar
  35. 35.
    El-Serag HB. Impact of irritable bowel syndrome: prevalence and effect on health-related quality of life. Rev Gastroenterol Disord. 2003;3:S3–S11.Google Scholar
  36. 36.
    Hahn BA, Kirchdoerfer LJ, Fullerton S, et al. Patient-perceived severity of irritable bowel syndrome in relation to symptoms, health resource utilization and quality of life. Aliment Pharmacol Ther. 1997;11:553–559.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Moritz von Wulffen
    • 1
    • 2
    • 3
  • Nicholas J. Talley
    • 4
  • Johann Hammer
    • 2
    • 3
    • 5
  • Jessica McMaster
    • 1
    • 2
    • 3
  • Graeme Rich
    • 1
    • 2
    • 3
  • Ayesha Shah
    • 1
    • 2
    • 3
  • Natasha Koloski
    • 1
    • 2
    • 4
  • Bradley J. Kendall
    • 1
    • 2
    • 3
  • Mike Jones
    • 6
  • Gerald Holtmann
    • 1
    • 2
    • 3
    • 7
    Email author
  1. 1.Department of Gastroenterology and HepatologyPrincess Alexandra Hospital, BrisbaneBrisbaneAustralia
  2. 2.Faculty of MedicineUniversity of QueenslandBrisbaneAustralia
  3. 3.Translational Research InstituteBrisbaneAustralia
  4. 4.Faculty of Health and MedicineUniversity of NewcastleNewcastleAustralia
  5. 5.Medical University of ViennaViennaAustria
  6. 6.Department of PsychologyMacquarie UniversitySydneyAustralia
  7. 7.Faculty of Health and Behavioural SciencesUniversity of QueenslandBrisbaneAustralia

Personalised recommendations