Review
Insights Into Gastroesophageal Reflux Disease–Associated Dyspeptic Symptoms

https://doi.org/10.1016/j.cgh.2011.05.015Get rights and content

Background & Aims

Patients with GERD frequently report dyspeptic-like symptoms, including nausea, vomiting, early satiety, bloating, and belching. The purpose of this review was to define the epidemiology and underlying mechanisms for dyspeptic symptoms in GERD patients.

Methods

We performed a systematic literature review to identify the prevalence of dyspeptic symptoms in GERD patients. We identified 2057 studies, and 37 studies (2%) met the entry criteria, including 17 articles describing the prevalence of dyspeptic symptoms in GERD subjects, 7 studies describing mechanistic evaluation of dyspeptic symptoms in GERD, 7 studies describing questionnaires used to measure dyspeptic symptoms, and 6 studies assessing the role of proton pump inhibitor therapy for dyspeptic symptoms associated with GERD. We used an evidence-based approach to assess the literature.

Results

The median (± standard deviation) prevalence of GERD in 30,384 subjects from 8 studies conducted in Western countries was 30% ± 8% (range, 20%–40%). Dyspeptic symptoms were present in 38% ± 14% (range, 21%–63%) and were more frequent in patients with frequent GERD symptoms, compared with patients with intermittent or no GERD symptoms [Evidence B]. Patients with nonerosive disease had a higher prevalence of dyspeptic symptoms [Evidence B] in addition to a lower response to proton pump inhibitor therapy [Evidence A], compared with patients with erosive esophagitis. Epigastic pain, belching, bloating, and early satiety demonstrated improvement on PPI therapy [Evidence A], compared with symptoms of nausea and vomiting that did not improve [Evidence A]. Patients with dyspepsia were at risk for a subsequent new diagnosis of GERD [Evidence B]. Dyspeptic symptoms contributed significantly to the decrement in health-related quality of life associated with GERD.

Conclusions

Dyspeptic symptoms are common in GERD patients and impact health-related quality of life.

Section snippets

Methods

We performed a systematic review of the literature by using Ovid Medline, Cochrane Library, Web of Science, and BIOSIS Previews from 1965–2009. To be included in the analysis, studies were required to include the term heartburn, regurgitation, and/or GERD with the following terms including dyspepsia, bloating, nausea and/or vomiting, early satiety, and abdominal pain. The results of the search are demonstrated in Figure 1. We did not include atypical symptoms of GERD including dysphagia,

Conclusions

Although GERD is common in the general population, the association of heartburn with dyspeptic symptoms including epigastric pain, bloating, early satiety, and nausea/vomiting has not been fully appreciated. This systematic review demonstrated that dyspeptic symptoms are present in approximately one-third of GERD patients and are more common in GERD patients compared with controls. Although it remains unclear whether dyspepsia and GERD are separate disease entities or coexisting conditions in

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    Conflicts of interest The authors disclose the following: Dr Gerson has served as a consultant to Takeda, Eisai, Depomed, and XenoPort. She has received research funding from Santarus and XenoPort ii. Dr Kahrilas has served as a consultant for AstraZeneca, EndoGastric Solutions, Novartis, Movetis, Revalesio, XenoPort, ARYx Therapeutics, and Eisai. He has received research funding from National Institutes of Health and Reckitt Benckiser Group, plc. Dr Fass has served as a speaker for Takeda and Given Imaging and served as a consultant to GSK, Eisai, Xenoport, and Vecta. He has received research funding from AstraZeneca.

    Funding The writing and preparation of this article were funded by Eisai, Inc, Woodcliff Lake, New Jersey, and Ortho-McNeil Janssen Scientific Affairs, LLC, Raritan, New Jersey. Partial writing support was provided by International Meetings & Science.

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