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

Abstract

There is symptom overlap between gastro-esophageal reflux disease (GERD) and functional dyspepsia (FD). We aimed to test the hypothesis that FD cases are now more likely mislabeled as GERD. In subjects from Olmsted County, MN seen at Mayo Clinic: (i) Investigation of GERD and FD diagnosis rates between 1985 and 2009. (ii) Assessment of survey-based upper gastrointestinal symptoms between 1988 and 2009. (iii) Analysis of patients reporting GERD and/or FD symptoms and subsequently receiving a consistent diagnosis of GERD and/or FD during a medical encounter. (iv) Assess the association between PPI use and GERD and/or FD symptoms and between actual diagnoses received. (i) Yearly GERD diagnosis rates rose between 1985 and 2009 (325-1866 per 100000). FD diagnosis rates rose from 45 in 1985, to 964 in 1999 but decreased to 452 per 100000 in 2009. (ii) Reported GERD symptoms did not significantly change between three survey waves in the years 1988-2009 (p=0.052), whereas FD symptoms slightly increased (p=0.01). (iii) 62.9% of subjects reporting GERD symptoms received a GERD diagnosis, however only 12.5% of subjects reporting FD symptoms received a FD diagnosis. (iv) PPI use was associated with documented GERD diagnosis (p<0.001), however there was no significant association between GERD symptoms and PPI use (p=0.078). We have found evidence supporting a systematic bias away from diagnosing FD, favoring a GERD diagnosis.