Dyspeptic symptoms improvement in patients with non-erosive reflux disease is correlated with the degree of intragastric acid inhibition.

Functional dyspepsia and non-erosive reflux disease (NERD) are highly prevalent functional diseases. In both the diseases symptoms overlap can be expected by chance alone, but recent data indicated that acid may be the common factor to explain symptoms generation. Indeed, esophageal acid perfusion has been recently associated with the onset of dyspeptic symptoms in healthy volunteers. Our aim was to study the effect of acid and its suppression, by PPI therapy, on NERD patients with dyspeptic symptoms. Hundred-twenty consecutive patients with reflux-associated symptoms were studied. Sixty-nine of them were selected because they were found to have non-erosive reflux disease during upper GI endoscopy and fulfilled the Rome criteria for functional dyspepsia. A standardized questionnaire, assessing the severity (effect on daily activities, from 0 to 3) of belching, abdominal bloating, early satiety, epigastric pain and burning, nausea, vomiting and postprandial fullness, and an esophagogastric 24hr pHmetry were performed before and at 4th week therapy with esomeprazole 20 mg bid. Intragastric acid inhibition was evaluated as the % of pH >3 and symptoms improvement was considered effective if a reduction of dyspepsia severity score (at least 50%) respect to baseline was obtained. Esophageal basal acid exposure (pH<4 > 4%) was pathological in 44 pts, whereas it was normal in 25. No significant difference was observed in the prevalence and the severity of individual dyspeptic symptoms. At baseline the intragastric % pH >3 was similar in subjects with normal and abnormal acid exposure (19±3.8 vs 18±4.5, p=NS). During esomeprazole therapy, reflux-associated symptoms improved in the majority of patients, but 7/69 patients had persistent pathological esophageal acid exposure. Overall PPI therapy significantly improved dyspeptic symptoms in 42/69 patients. Dyspepsia improvement was present in a higher number of patients with abnormal than in those with normal basal acid exposure (31/44 vs 11/25, respectively, p<0.05), with the former having a longer intragastric acid suppression (78±2.6 vs. 65±5.4 %pH >3, p<0.05). Our findings confirm that functional dyspepsia may coexist in patients with non-erosive reflux disease. A four-week treatment with esomeprazole is effective in reducing dyspeptic symptoms in 60% of subjects with NERD. Furthermore, a better improvement of dyspeptic symptoms seems dependent on the extent of intragastric acid suppression