Prevalence Of Functional Dyspepsia Research Articles

Epidemiological and clinical features of functional dyspepsia in a region with a high incidence of esophageal cancer in China.

Background:Functional dyspepsia (FD) has rarely been investigated in areas with a high prevalence of esophageal squamous cell carcinoma (ESCC). This study aims to reveal the epidemiological and clinical features of FD and organic dyspepsia (OD) in such a population.Methods:A middle-aged and elderly population-based study was conducted in a region with a high incidence of ESCC. All participants completed the Gastroesophageal Reflux Disease Questionnaire and Functional Gastrointestinal Disease Rome III Diagnostic Questionnaire, and they underwent gastroscopy. After exclusion of gastroesophageal reflux disease, uninvestigated dyspepsia (UID) was divided into OD and FD for further analyses.Results:A total of 2916 participants were enrolled from July 2013 to March 2014 in China. We detected 166 UID cases with questionnaires, in which 17 patients with OD and 149 with FD were diagnosed via gastroscopy. OD cases presented as reflux esophagitis (RE), ESCC, and duodenal ulcer. Heartburn (52.94%) and reflux (29.41%) were common in OD, but no symptomatic differences were found between FD and OD. Male sex, low education level, and liquid food were the risk factors for OD, while frequent fresh vegetable consumption was a protective factor. FD included 56 (37.58%) cases of postprandial distress syndrome (PDS), 52 (34.89%) of epigastric pain syndrome (EPS), nine (6.04%) of PDS + EPS, and 32 (21.48%) of FD + functional esophageal disorders. The Helicobacter pylori infection rate in FD patients was not higher than that in the control group (34.23% vs. 42.26%, P = 0.240). Frequent spicy food consumption was associated with PDS (odds ratio [OR]: 2.088, 95% confidence interval [CI]: 1.028–4.243), while consumption of deep well water was protective for PDS (OR: 0.431, 95% CI: 0.251–0.741).Conclusions:The prevalence of FD was 5.11% in the studied population. Gastroscopy should be prescribed for dyspepsia patients in case that ESCC and RE would be missed in UID cases diagnosed solely by the Rome III questionnaire.Trial Registration:ClinicalTrials.gov, NCT01688908; https://clinicaltrials.gov/ct2/show/record/NCT01688908.

Overlap of functional dyspepsia and irritable bowel syndrome by revised Rome IV criteria: meta-analysis

Introduction. Functional dyspepsia (FD) and irritable bowel syndrome (IBS) overlap is an adverse clinical situation, as patients with this syndrome have more severe clinical manifestations resulting in significant reductions in quality of life. For now, there are no meta-analytical papers that would summarize the frequency of FD – IBS overlap using the revised Rome IV criteria. Objective. To organize data on the prevalence of FD – IBS overlap using the revised Rome IV criteria.Materials and methods. A search for studies was conducted in MEDLINE / PubMed, EMBASE, Cochrane electronic databases. The search depth was 6 years (from January 2016 to February 2021). The final analysis included original publications from peerreviewed periodicals that used the revised Rome IV criteria as a method for diagnosing FD and IBS in the adult population with detailed descriptive statistics allowing to include resulting data in the meta-analysis.Results and discussion. The final analysis included 6 studies involving 1,180 patients with PD and 600 patients with IBS. The generalized prevalence of IBS in patients with PD was 41.511% (95% CI: 22.203–62.288). The analysis was undertaken by using a random-effects model, as there was significant heterogeneity among results (p < 0.0001; I2 = 94.28%). The generalized prevalence of PD in patients with IBS was 38.791% (95% CI: 9.438–73.710). The analysis was undertaken by using a random-effects model, as there was significant heterogeneity among results (p < 0.0001; I2 = 99.25%).Сonclusion. The complete meta-analysis showed that the frequency of FD - IBS overlap using the revised Rome IV criteria is quite high and accounts for about 40%. At the same time, further large studies of more homogeneous structure are needed to verify these results and study the potential pathogenetic relationship between PD and IBS.

Frequency, Intensity, and Partner of Exercise Habit Is Inversely Associated with Functional Dyspepsia in Young Japanese Population.

Functional dyspepsia (FD) has a high prevalence worldwide and reduces patients' quality of life. The etiology of FD is likely multifactorial. Although two studies showed an inverse association between exercise habits and FD, evidence regarding the association between exercise habits and FD remains scarce. This study aimed to investigate the association between exercise habits and FD among the young Japanese population, taking the presence or absence of an exercise partner as an additional variable. The study subjects consisted of 8923 Japanese university students. The definition of FD was based on the Rome III criteria. Information on exercise frequency, exercise intensity, and exercise partners was obtained from a self-administered questionnaire. The prevalence of FD was 1.9% in this cohort. Low, moderate, and high frequency of exercise was independently inversely associated with FD (adjusted odds ratio [OR] was low: OR 0.69 [95% confidence interval (CI) 0.47-0.997], moderate: OR 0.53 [95% CI 0.34-0.81] and high: OR 0.53 [95% CI 0.30-0.88], p for trend p = 0.002). Moderate and high intensity of exercise was independently inversely associated with FD (moderate: OR 0.56 [95% CI 0.36-0.84] and high: OR 0.49 [95% CI 0.30-0.76], p for trend p = 0.001). Exercise with groups and with friends was independently inversely associated with FD whereas the association between exercising alone and FD was not significant (groups: OR 0.28 [95% CI 0.14-0.50] and friends: OR 0.44 [95% CI 0.24-0.74]). Among the young Japanese population, frequency and intensity of exercise may be independently inversely associated with FD. Additionally, exercise with groups and with friends but not by oneself was inversely associated with exercise and FD, respectively.

The relationship between fruit and vegetable intake with functional dyspepsia in adults.

The association of fruit and vegetables with functional dyspepsia (FD) has been less studied, especially in Middle Eastern populations. This study investigated the relationship between fruit and vegetable consumption with FD and its related symptoms among a large group of Iranian adults. This cross-sectional research was conducted on 3362 middle-age participants. Usual dietary intakes, including fruit and vegetable intake, during the last year were assessed using a validated 106-item dish-based food frequency questionnaire (FFQ). A modified Persian version of the Rome III questionnaire was used for assessment of FD. The prevalence of FD among study participants was 14.5%. After adjustment for confounders, the highest energy-adjusted tertile of fruit consumption was related to 32% lower risk of FD, compared to the lowest intake (OR=0.68, 95% CI:0.51-0.90). Fruit consumption was also significantly related to lower risk of early satiation (OR=0.67, 95% CI:0.54-0.85) and post-prandial fullness (OR=0.75, 95% CI:0.61-0.92). Vegetable consumption was not related to the risk of FD in all models. Men who were in the third tertile of fruit and the third tertile vegetable consumption had lower risk of FD compared to the first tertile; but, in women, just fruit consumption was related to the reduced risk of FD, after adjustment for all confounders. We found an inverse association between fruit intake and dyspepsia symptoms. In addition, high consumption of fruit was related to lower odds of early satiation and post-prandial fullness. Higher intake of vegetables was associated with lower risk of FD, only in men.

MODERN APPROACH TO DYSPEPSIA.

SUMMARYDyspepsia is a disorder characterized by dyspeptic symptoms which are located in the epigastrium and related to digestion of food in the initial part of the digestive system. In functional dyspepsia, unlike organic dyspepsia, there is no underlying organic disease that would cause dyspeptic symptoms. Immune and mucosal function changes, gastric dysmotility, different composition of the gastrointestinal microbiota, and altered central nervous system processing are considered responsible for the onset of the disorder. The diagnosis is based on history, clinical presentation, and exclusion of other organic diseases of the gastrointestinal tract manifested by dyspeptic symptoms. Therapy includes eradication of Helicobacter pylori infection, proton pump inhibitors, prokinetics, neuromodulators, and herbal preparations. Unfortunately, in some patients, this therapy leads to little or no improvement. The prevalence of functional dyspepsia is increasing. It has become one of the more common gastroenterological diagnoses. In order to reduce the costs associated with the diagnosis and treatment of the disorder itself, its mechanisms need to be fully elucidated and thus enable finding appropriate therapy for all patient subgroups.

Effects of the Rome IV Criteria to Functional Dyspepsia Symptoms in Saudi Arabia: Epidemiology and Clinical Practice

Limited data is available in Saudi Arabia (SA) regarding the prevalence of functional dyspepsia (FD) symptoms and its subtypes, as defined by the ROME IV criteria. This study evaluated the burden of self-reported FD symptoms in the adult general population of SA and the current clinical practices. A web-based national cross-sectional health survey of the general population of SA was conducted using the Rome IV Diagnostic Questionnaire for Functional Gastrointestinal Disorders in Adults with additional questions on the presence of symptoms compatible with functional heartburn (FH) and irritable bowel syndrome (IBS). The quality of life and somatization questionnaires were also included. Overall, 3,114 adults completed the questionnaire, but 303 (9.7%) were excluded due to inconsistent responses. Of the 2,811 consistent responders, 532 (18.3%) fulfilled the Rome IV criteria for FD symptoms. These were distributed into the FD subtypes as follows: 208 (7.4%) had postprandial distress syndrome, 228 (8.1%) had epigastric pain syndrome, and 96 (3.4%) had the overlapping variant. IBS-like symptoms were reported in 232 (44%) and FH in 102 (19%) 19% (102) of the subjects with functional dyspepsia. H. pylori-associated dyspepsia was reported by 25% (87/348). High somatization, lower quality of life scores, younger age, and female sex were associated more with the FD symptoms participants than those without. Approximately 1/5 respondents used over-the-counter medications to relieve the FD symptoms. In this population-based survey, FD affected almost 1/5 of the responding adult population in SA, which was less than previously reported.

Modern aspects of the pathogenesis and treatment of dyspepsia

A review of current data suggests that the attention to the problem of dyspepsia is huge. The definition of functional dyspepsia was given in the Rome IV criteria, according to which two of its main options are distinguished – epigastric pain syndrome and postprandial distress syndrome. The term “uninvestigated dyspepsia” is important, which means the presence of dyspepsia symptoms in patients who have not performed diagnostic procedures to identify the organic causes of the pathology. The prevalence of uninvestigated dyspepsia in the world is about 21%. The prevalence of functional dyspepsia is significantly lower than the prevalence of uninvestigated dyspepsia and fluctuates around 10%. The risk factors for dyspepsia are usually tobacco smoking, non-steroidal anti-inflammatory drugs and/or aspirin, and Helicobacter pylori infection. The concept of the pathogenesis of functional dyspepsia undergoes significant changes. By analogy with the pathophysiology of irritable bowel syndrome, lesions of the relationship between the modulation of the cerebral cortex and the signal system of the gastroduodenal zone, the association of sluggish immune inflammation in the duodenum with motility and sensory activity of the stomach are most actively studied. The treatment of functional dyspepsia is a complex problem and changes after new ideas about its pathogenesis. Modern meta-analyzes have made it possible to expand the indications for the proton pump inhibitors administration, which can be actively used not only for the treatment of epigastric pain syndrome, but also for postprandial distress syndrome. Along with the required Helicobacter pylori eradication, there are reasons for the use of probiotics and antibiotics for the dyspepsia treatment.

An Increasing Incidence of Upper Gastrointestinal Disorders Over 23 Years: A Prospective Population-Based Study in Sweden.

We hypothesized that the prevalence of functional dyspepsia and gastroesophageal reflux disease in the community may be increasing. Randomly selected adults were surveyed on 4 occasions: 1988 (n = 1,151, 21-79 years, response rate [rr] = 90%), 1989 (n = 1,097, 22-80 years, rr = 87%), 1995 (n = 1,139, 20-85 years, rr = 76%), and 2011 (n = 1,175, 20-93 years, rr = 63%). In functional dyspepsia, the odds of postprandial distress syndrome tripled over 23 years' follow-up (odds ratio [OR]: 3.55; 95% confidence interval [CI]: 2.60-4.84, mixed-effect regression analysis), whereas a small decrease in epigastric pain syndrome was observed (OR: 0.65, 95% CI: 0.42-1.00). The odds of reporting gastroesophageal reflux disease doubled (OR: 2.02; 95% CI: 1.50-2.73). The underlying mechanisms behind the increase in postprandial distress syndrome and gastroesophageal reflux disease remain to be determined.

Prevalence of Irritable Bowel Syndrome, Functional Dyspepsia and their Overlap in Bulgaria: a Population-Based Study.

We aimed to evaluate the prevalence of irritable bowel syndrome (IBS), functional dyspepsia (FD), and their overlap syndrome (OS) in the Bulgarian population and to assess the risk factors associated with these disorders. We sent an internet-based survey to Bulgarian adults. The survey collected data on socio- demographic, behavioral and lifestyle characteristics, and diagnostic questions following the Rome IV criteria to assess IBS, FD and their overlap occurrence. Data was collected from 1,896 individuals (mean age = 35.5 years, 18-65, SD=11.7), 73.1% females. The prevalence of IBS was 20% (14% were with predominant constipation, 32% with predominant diarrhea, 52% had IBS with mixed bowel habits, and 2% unclassified IBS). Gender (p=0.005), age (p<0.001), marital status (p=0.009), occupation (p=0.001), alcohol consumption (p=0.013), sexual problems (p<0.001), FD (p<0.001), and milk intolerance (p<0.001) were significantly associated with IBS. Females (p=0.032; OR: 1.50), patients with FD (p<0.001; OR: 104.98), sexual problems (p= 0.001; ОR: 1.55 ), and milk intolerance (p<0.001; OR: 2.22) are at a higher risk of having IBS. The prevalence of FD was 12.7% (39% had postprandial distress syndrome, 33% epigastric pain syndrome, and 28% had the overlapping variant). Patients with IBS (p<0.001; OR: 127.88) and milk intolerance (p<0.001) were significantly associated with FD prevalence. The prevalence of OS was 11.7%. Gender (p=0.013), milk intolerance (p<0.001, OR: 1.65), urinary (p=0.035) and sexual problems (p<0.001, ОR: 1.80) were associated with OS prevalence. This is the first study to estimate the prevalence of IBS, FD, and their OS and assess the behavioral and demographic risk factors associated with these disorders in the Bulgarian population. Our results are valuable in filling in the epidemiological data gap regarding IBS, FD, and OS in Eastern Europe.

Correlation between lifestyle and social factors in functional dyspepsia among college freshmen.

ObjectiveWe aimed to examine the relationship between the prevalence of functional dyspepsia (FD) and lifestyle habits, to identify social factors that may contribute to psychosocial disorders.MethodsWe enrolled 759 university freshmen in this study, who were categorized into the FD group and healthy group. All participants completed the validated Self-Rating Depression Scale and Self-Rating Anxiety Scale questionnaires, to assess lifestyle and social factors among participants.ResultsThe proportion of participants with FD was 16.86%, and 67.97% were women. Diet irregularities and sleep impairment may have an effect on FD. Tea consumption may play a role in preventing FD. Participants with FD were more likely to have mood disorders than healthy participants. Most participants with FD who had mood disorders experienced mild anxiety or depression. Participants’ main sources of stress arose from daily life, development, social life, life events, and participants’ daily schedule.ConclusionSex and lifestyle habits, including sleeping patterns and dietary habits, can have an impact on FD. Social stress and mood disorders also have an effect on FD. FD may be prevented by adjusting lifestyle habits and psychological counseling.

Prevalence of functional dyspepsia-like symptoms in ulcerative colitis patients in clinical remission and overlap with irritable bowel syndrome-like symptoms

Objective: Quiescent ulcerative colitis (UC) patients often have irritable bowel syndrome (IBS)-like symptoms and we recently showed that the prevalence of IBS-like symptoms in UC patients in clinical remission was significantly higher as compared to healthy control subjects. However, the prevalence of functional dyspepsia (FD)-like symptoms in quiescent UC patients remains unknown. The purpose of this study was to evaluate the prevalence of FD-like symptoms and the overlap with IBS-like symptoms in such patients.Materials and Methods: We reanalyzed the records of UC patients in remission using the subject cohort from our previous study. Clinical remission was defined as a clinical activity index (CAI) value ≤4 for at least 6 months. Diagnoses of FD- and IBS-like symptoms were evaluated by questionnaire according to the Rome III criteria.Results: One hundred seventy-two UC patients in clinical remission and 330 healthy control subjects were analyzed. Of the 172 patients, 9 (5.2%) met the criteria of FD, which was comparable with the controls (22/330, 6.7%). The prevalence rate of FD-like symptoms in UC patients with IBS-like symptoms (7/46, 15.2%) was lower as compared to that of the control subjects (6/16, 37.5%). On the other hand, a high percentage of the UC patients with FD-like symptoms also had IBS-like symptoms (7/9, 77.8%).Conclusions: Although the prevalence of FD-like symptoms in quiescent UC patients with IBS-like symptoms was low, UC patients with FD-like symptoms frequently had IBS-like symptoms.

Non-pharmacological Approach in the Management of Functional Dyspepsia.

Functional dyspepsia (FD) is a common functional gastrointestinal disease which bears a significant burden on society and individuals. Despite the high prevalence of FD, its pathophysiology remains poorly understood and the treatment options are limited and unsatisfactory. In the absence of effective pharmacological treatments for FD, non-pharmacological approaches, including: reassurance, lifestyle modification, psychotherapy, dietary interventions, medical food, acupuncture, and electrical stimulation and modulation are sought after by many physicians and FD patients. In this article, we review clinical studies which investigate non-pharmacological therapies for FD. We will also discuss potential mechanisms involved in the therapeutic effects of these non-pharmacological approaches. Though the evidences to support the routine use of the non-pharmacological management is still lacking, the non-invasive nature and potentially minimal side-effects of these therapies may be attractive in the FD management. In order to confirm the clinical effectiveness of these non-pharmacological approaches, more well-conducted, methodologically rigorous, and large-scaled clinical trials are required.

Comparison of Decision Tree and Logistic Regression for Prediction of Functional Dyspepsia and Gastroesophageal Reflux Disease in Tehran Province Using Rome III

Background: Different procedures can be used to develop predictive models for medical data with binary response. In this study, we aimed to probe the process of developing common predictive models, including decision tree (DT) and logistic regression (LR). Also, we investigated how to set the model parameters, how to develop accurate models efficiently, and how to determine the prediction efficiency. Objectives: The main purpose of this study was to find the prevalence and risk factors associated with functional dyspepsia (FD) and gastroesophageal reflux disease (GRED) in a sample of the Iranian population. Methods: This cross-sectional study was conducted in Tehran, from May 2016 to December 2017, on 18,180 participants who were selected randomly and interviewed using a reliable questionnaire. Results: The areas under the ROC curve (AUC) of DT and LR were 0.93 and 0.94 for GERD and 0.98 and 0.95 for FD, respectively. Generally, 63.8% and 37.2% of the participants had FD and GRED, respectively. The results of multiple logistic regression analysis showed that men had a higher risk of FD than women. The prevalence of FD increased with increasing age. Conclusions: This study showed a low rate of FD and GERD among urban people of Tehran. Also, the prediction results of both models were approximately similar. Therefore, when we deal with multiple independent variables and a binary response variable in data from a large sample, more statistical techniques and strategies should be considered in developing a prediction model.

PREVALENCE OF FUNCTIONAL DYSPEPSIA SYMPTOMS IN PATIENTS WITH ASTHMA

Gastroesophageal reflux disease (GERD) is a common comorbidity among patients with asthma. In addition, functional dyspepsia (FD) is characterized by upper abdominal symptoms without organic disease manifestations. However, the prevalence of FD among patients with asthma remains uninvestigated; therefore, herein, we investigated the prevalence of dyspepsia symptoms in these patients. We recruited 156 patients with asthma from the outpatient clinic of Teikyo University Hospital and investigated the prevalence of dyspepsia symptoms using the modified Frequency Scale for the Symptoms of GERD. Further, the relationship between dyspepsia symptoms and clinical background of asthma was also investigated. Certain digestive organ symptoms were exhibited by 83% of patients with asthma, dyspepsia symptoms by 44%, and reflux symptoms by 26%. The dyspepsia-dominant group showed significantly higher female ratio and numerically lower %FEV1 than the asymptomatic group. In the group with dyspepsia score >5 points, the ratio of patients undergoing step 4 asthma treatment and the ratio of those using long-acting muscarinic receptor antagonist were higher than those in the group with a score <5 points. Furthermore, endoscopic diagnosis was also made in 84 patients and the prevalence of FD was 21%. A considerable proportion of patients with asthma exhibited dyspepsia symptoms, and the asthma severity in patients with dyspepsia was higher than those in asymptomatic patients. Based on the current findings, more attention should be directed to FD, in addition to GERD, as a comorbidity of the digestive system in patients with asthma.

The Relation between Dietary Patterns and Functional Gastrointestinal Disorders among Iranian Military Men.

Background:Assessing the relation between dietary habits and functional gastrointestinal disorders (FGIDs) is less investigated among military personnel. In this study, we aimed to evaluate the association of certain eating patterns and FGIDs in Iranian army men.Materials and Methods:This cross-sectional study was performed on 600 army personnel working in Kerman ground forces military station number 05, Iran. Participants were asked to define their weekly breakfast consumption, lunch intake time, and chewing efficiency. FGIDs were categorized as four groups including functional dyspepsia (FD), irritable bowel syndrome (IBS), functional constipation (FC) and functional diarrhea (FDi) diagnosed by Rome Ш criteria. Relation between variables was assessed through crude and multiple stepwise adjusted models.Results:The prevalence of FD, IBS, FC, and FDi in our study was 20%, 32.3%, 3%, and 53.2%, respectively. After adjustment of all potential confounding variables, more weekly breakfast consumption was associated with decreased FDi prevalence (odds ratio [OR]: 0.57, 95% confidence interval [CI] = 0.38–0.84, P = 0.005). Slowly lunch consumption declined prevalence of IBS (OR: 0.33, 95% CI = 0.13–0.84, P = 0.02). Individuals chewing their meals well had a lower percentage of IBS, FC, and FDi (OR: 0.53, 95% CI = 0.33–0.83, P = 0.006; OR: 0.24, 95% CI = 0.06–0.89, P = 0.03; and OR: 0.52, 95% CI = 0.34–0.79, P = 0.003, respectively).Conclusions:This study suggested that increasing breakfast intake, slowly lunch consumption, and better food chewing could be effective decreasing FGIDs' prevalence and increasing army crews' quality of lives and work efficiency. Further studies required to confirm this relationship and define accurate pathophysiological mechanisms.

Prevalence and Risk Factors of Functional Dyspepsia in Health Check-up Population: A Nationwide Multicenter Prospective Study.

Background/AimsFunctional dyspepsia (FD) is one of the most common gastrointestinal disorders, and FD imposes social and economic burden worldwide. The aim of this study is to identify the prevalence and risk factors of FD in health check-up population in tertiary centers in Korea.MethodsA nationwide multicenter prospective study was performed at 9 tertiary healthcare centers in Korea between September 2016 and June 2017. A total of 2525 subjects were investigated based on endoscopic findings and questionnaires with the Rome III criteria, and Helicobacter pylori serology (IgG).ResultsA total of 1714 subjects without organic disease were enrolled. The mean (± SD) age was 51.5 (± 12.7) years, and 917 patients (53.5%) were female. The proportion of H. pylori seropositivity was 51.0% (874/1714). The prevalence of FD was 10.3% (176/1714), and the subtypes of postprandial distress syndrome alone, epigastric pain syndrome alone, and postprandial distress syndrome-epigastric pain syndrome overlap were 4.8%, 3.0%, and 2.5%, respectively. Multivariate analysis showed that female gender (OR, 1.58; 95% CI, 1.14–2.21) and education below college level (OR, 1.45; 95% CI, 1.01–2.07) were related to FD. Multivariate analysis based on age 60 showed female gender as a significant (OR, 2.90; 95% CI, 1.06–7.94) factor in the group ≥60 years.ConclusionsThe prevalence of FD was 10.3% in the health check-up population in Korea. Female sex and education below college level were risk factors for FD. Female sex is a risk factor for FD in old age, underscoring the need for close attention in this age group.

Tu1585 - Prevalence of Functional Dyspepsia, Anxiety and Depression Among African Patients with Dyspepsia Undergoing Endoscopy

Tu1585 - Prevalence of Functional Dyspepsia, Anxiety and Depression Among African Patients with Dyspepsia Undergoing Endoscopy

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

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.

Functional Dyspepsia Symptoms Are Strongly Associated With Coeliac Disease: Results From a Population-Based Study

Introduction: Coeliac disease (CD) is estimated to affect up to 1 in 100 Australians. Although CD has a wide range of clinical manifestations, patients frequently present with gastrointestinal (GI) symptoms which overlap with functional GI disorders such as irritable bowel syndrome (IBS) or functional dyspepsia (FD).Patients with CD have been shown to experience persistent GI symptoms despite long term treatment with a gluten free diet. Methods: The aim of this study was to define GI symptoms reported in an Australian cohort with a doctor diagnosis of CD and compare with those not reporting CD. A total of 3825 people (mean age 58.4 years, age range 18-100 years and 47.5% males) randomly selected from the Australian population returned a mail survey (Digestive Health & Wellbeing Survey, response rate=45%) which contained questions on whether the participant had ever been told by a physician that they had CD, and GI symptom questions to establish whether they had co-existent functional GI disorders. Adherence to a gluten free diet was not assessed. Prevalence of CD, FD and IBS are reported with 95% exact confidence intervals. The difference between symptoms in CD compared with the unaffected population was tested for significance using a Pearson chi-square test. Results: The prevalence of doctor diagnosed CD was 1.17% in this cohort. Subjects with CD reported significantly higher levels of GI symptoms than unaffected individuals, including abdominal pain associated with abnormal bowel habit, diarrhoea, bloating, distention, epigastric burning and early satiety (see Table 1). There was no significant difference observed in symptoms of post-prandial fullness, nausea, constipation, abnormal stool consistency, or straining with defecation. The prevalence of FD as defined by Rome III criteria in the CD cohort was 37.5% (95% CI 22.7-54.2) compared to 13.9% (95% CI 12.8- 15.1) in the non-affected population (OR 3.7, 95% CI 1.9-7.1, p < 0.001). There was no significant difference in the prevalence of IBS in the affected compared with the non- affected cohort (30.8% versus 22.2%, p=0.2).Table: Table. Gastrointestinal symptoms reported in patients with and without coeliac disease (CD). Items reported as greater than one day per week (*) or greater than or equal to “often” (**)Conclusion: The prevalence of gastrointestinal symptoms and a diagnosis of functional dyspepsia are significantly higher in patients with a doctor diagnosis of CD than in the unaffected population.

Constipation in adults with neurofibromatosis type 1

BackgroundNeurofibromatosis type 1 (NF1) is an autosomal-dominant disease characterised by symptoms of the skin, eyes, nervous system and bones. A previous study indicated that constipation, large rectal diameters and prolonged colorectal transit times are common in children with NF1. The aim of the present study was to investigate and compare the prevalence of gastrointestinal symptoms in adult patients with NF1 to their unaffected relatives serving as the control group. Patients with NF1 were recruited from one of two Danish National Centres of Expertise for NF1 and their unaffected relatives were invited to participate as controls. Gastrointestinal symptoms were assessed with a web-based, self-administered, validated, Rome® III diagnostic questionnaire. Logistic regression was used to estimate the prevalence of functional dyspepsia, IBS and functional constipation in each group and the groups were compared using their odds ratios.ResultsThe response rates for patients and controls were 66.4% and 82.4%, respectively. We compared 175 patients, median age 34.2 (IQR = 20.1) and 91 of their unaffected relatives, median age 42.0 (IQR = 12). The overall likelihood of fulfilling the diagnostic criteria for functional constipation, irritable bowel syndrome or functional dyspepsia was 33.1% among patients vs. 14.3% among controls, (odds ratio (OR): 2.97; 95% CI: 1.56–5.66) and after adjustment for age and gender (OR: 3.06; 95% CI: 1.62–5.79). The likelihood of functional constipation was higher among patients (OR: 3.80; 95% CI: 1.27–11.31), and this was still true after adjustment (OR: 3.49; 95% CI: 1.14–10.64). The likelihood of irritable bowel syndrome (OR: 2.29; 95% CI: 0.98–5.33) was evident after adjustment (OR: 2.46; 95% CI: 1.10–5.47), whereas there was no difference in the likelihood of functional dyspepsia (OR: 2.35; 95% CI: 0.67–8.32) after adjustment (OR:2.25; 95% CI: 0.70–7.17).ConclusionsOverall, having symptoms usually attributed to either functional dyspepsia, IBS or functional constipation is more common in adults with NF1 compared to unaffected relatives. Of the three, the likelihood of constipation is markedly higher. The high prevalence of constipation indicates that it is not functional but part of the NF1 disorder.