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Overlap of Dyspepsia in Patients with Gastroesophageal Reflux Disease: Impact of Clinical, Metabolic, and Psychosocial Characteristics

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Abstract

Background

Gastroesophageal reflux disease (GERD) and dyspepsia are highly prevalent in the general population with significant symptom overlap, while the interaction between both remains poorly understood.

Aim

To examine whether GERD overlapping dyspepsia would have an impact on clinical and psychological features as compared with GERD alone.

Methods

We performed a cross-sectional study in a GERD cohort (n = 868) that was previously recruited from a population-based GERD survey (n = 2752). We compared the clinical and psychological factors between patients with and without dyspeptic symptoms “epigastric pain or burning.” All participants were evaluated with Reflux Disease Questionnaire score, Pittsburgh Sleep Quality Index score, Taiwanese Depression Questionnaire score, and State-Trait Anxiety Inventory score. Endoscopic findings were classified according to the Los Angeles classification.

Results

Among the GERD population, 107 subjects had overlapping “epigastric pain or burning” (GERD-D), and 761 did not have these symptoms (GERD alone). GERD-D subjects had more severe GERD symptoms and were more often associated with irritable bowel syndrome (IBS) (OR 3.54, 95% CI 1.92–6.52) as compared subjects with GERD alone. In addition, GERD-D subjects had lower quality of sleep (OR 1.11, 95% CI 1.01–1.21), higher depression (OR 1.06, 95% CI 1.02–1.10), lower blood pressure (OR 0.45, 95% CI 0.22–0.95), and higher serum total cholesterol levels (OR 2.78, 95% CI 1.36–5.67) than GERD alone.

Conclusions

GERD-D subjects are characterized with worsening clinical symptoms as well as higher psychosocial, IBS, and metabolic comorbidities, but less erosive esophagitis. Our results indicate that clinical awareness of such overlapping condition would help optimize the management of GERD in clinical practice.

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Abbreviations

GERD:

Gastroesophageal reflux disease

IBS:

Irritable bowel syndrome

MS:

Metabolic syndrome

LA grade:

Los Angeles classification system grade

RDQ:

Reflux Disease Diagnostic Questionnaire

PSQI:

Pittsburgh Sleep Quality Index score

TDQ:

Taiwanese Depression Questionnaire score

STAI:

State-Trait Anxiety Inventory score

WHR:

Wait-to-hip ratio

BMI:

Body mass index

EE:

Erosive oesophagitis

IR:

Insulin resistance

NSAIDs:

Nonsteroidal anti-inflammatory drugs

PPIs:

Proton pump inhibitors

H2RAs:

Histamine-2 receptor antagonists

AC:

Serum fasting blood glucose

HbA1c:

Hemoglobin A1c

TG:

Triglyceride

TC:

Total cholesterol

LDL:

Low-density lipoprotein

HDL:

High-density lipoprotein

OR:

Odds ratio

CI:

Confidence interval

SBP:

Systolic blood pressure

DBP:

Diastolic blood pressure

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Acknowledgments

We thank all of whom helped to enroll and follow the study subjects. We are also grateful to the research assistants who assisted in laboratory analyses and collected clinical information. Finally, we would like to thank the anonymous reviewers and the editor for their constructive comments. All authors approved the final version of the article, including the authorship list.

Authors’ contributions

C-LC was involved in study concept and design. J-SH, T-TL, C-HY, W-YL, and C-LC were involved in acquisition of data. C-SH, S-HW, J-SH, and C-LC were involved in analysis and interpretation of data. C-SH, S-HW, J-SH, and C-LC drafted the manuscript. C-SH, S-HW, FP, and C-LC were involved in critical revision of the manuscript for important intellectual content. S-HW was involved in statistical analysis. C-SH and C-LC obtained the funding. C-SH, S-HW, and C-LC were involved in administrative, technical, or material support. C-LC was involved in study supervision.

Sources of funding and grant support

C-SH, S-HW, and C-LC had financial support from Hualien Tzu Chi Hospital and Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work. This work was supported by grants from the Hualien Tzu Chi Hospital and Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation (TCRD-TPE-106-RT-8, TCRD-TPE-104-31, TCMMP104-02-01, TCMMP104-02-02, TCMMP104-02-03).

Author information

Authors and Affiliations

  1. Division of Gastroenterology, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan, ROC

    Ching-Sheng Hsu

  2. School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan, ROC

    Ching-Sheng Hsu

  3. School of Medicine, Tzu Chi University, Hualien, Taiwan, ROC

    Ching-Sheng Hsu, Jui-Sheng Hung, Tso-Tsai Liu, Chih-Hsun Yi, Wei-Yi Lei & Chien-Lin Chen

  4. Department of Public Health, College of Medicine, Tzu Chi University, Hualien, Taiwan, ROC

    Shu-Hui Wen

  5. Division of Gastroenterology, Department of Internal Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 707, Sec. 3, Chung Yang Rd., Hualien, 970, Taiwan, ROC

    Jui-Sheng Hung, Tso-Tsai Liu, Chih-Hsun Yi, Wei-Yi Lei & Chien-Lin Chen

  6. Division of Gastroenterology, Department of Internal Medicine, ASST Bergamo Est, “Bolognini” Hospital, Seriate, Italy

    Fabio Pace

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  1. Ching-Sheng Hsu
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Correspondence to Chien-Lin Chen.

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Hsu, CS., Wen, SH., Hung, JS. et al. Overlap of Dyspepsia in Patients with Gastroesophageal Reflux Disease: Impact of Clinical, Metabolic, and Psychosocial Characteristics. Dig Dis Sci 62, 994–1001 (2017). https://doi.org/10.1007/s10620-017-4455-8

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  • DOI: https://doi.org/10.1007/s10620-017-4455-8

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