PPIS THERAPY NEEDING IN GERD PATIENTS WITH OVERLAPPING IRRITABLE BOWEL SYNDROME AND FUNCTIONAL DYSPEPSIA

Background and aim: Gastroesophageal reflux disease (GERD), irritable bowel syndrome (IBS) and functional dyspepsia (FD) are highly prevalent diseases and often overlap in the same patient. Aim of this study is to evaluate the prevalence of overlapping IBS and FD and how this affects the clinical course of GERD patients in terms of therapeutic needs.Material and methods: We enrolled 194 consecutive patients (101 female and 93 male; mean age of 47 years and BMI of 26) with clinical and instrumental diagnosis of GERD. At the diagnosis, presence of functional dyspepsia and irritable bowel was evaluated using standardized questionnaires according to Roma III criteria. At the enrolment, all subjects were treated with standard dosage of PPI for 6 weeks and, in case of GERD symptoms relapse, they were instructed to reintroduce PPIs on a continuous, cyclic, or on-demand fashion. After a 1 year follow-up the needing for additional therapy was recorded. Data were analysed by comparing the needs and the type of additional PPI therapy in the subgroup of patients with GERD alone or with overlapping dyspepsia and IBS. Results: At the enrollment 119/194 (61%) patients had dyspepsia, with 40 and 60% of the patients having postprandial distress syndrome and epigastric pain syndrome, respectively. IBS symptoms were reported by 34/119 (28%), with 45 and 32% having diarrhea and constipation prevalent IBS. Overall, 61% of the patients needed additional PPI therapy during the follow up, with higher percentage in the subgroup of patients with dyspepsia than in those with GERD alone 48, 68%, p < 0.05), but not in those with IBS (59%). As far as the therapy regimen, the number of subjects needing continuous PPI assumption was significantly higher in the subgroup of patients with dyspepsia and IBS than in those with GERD alone (9, 18 and 4%, respectively, p < 0.05). No significant differences were observed for other treatment regimens, nor subdividing dyspepsia and IBS patients within their respective subgroups. Conclusions: Our study showed that GERD patients with overlapping dys- pepsia or IBS need additional PPI therapy to control their reflux-related symptoms. Further studies looking at all the putative variables involved in symptom perception and response to therapy are needed in these subsets of patients.