Overlap of Esophageal Disorders of Gut-Brain Interactions and Gastroesophageal Reflux Disease Is Highly Prevalent in Patients With Refractory Reflux Symptoms

INTRODUCTION:Esophageal disorders of gut-brain interaction (E-DGBIs) are highly prevalent in patients with unproven gastroesophageal reflux disease (GERD) who do not respond to proton pump inhibitors (PPIs). The aim of this study was to determine the prevalence and characteristics of confirmed refractory GERD and E-DGBIs in consecutive patients with refractory reflux symptoms.METHODS:Patients with typical refractory reflux symptoms were prospectively enrolled. Data on age, sex, primary symptoms, pH and pH-impedance monitoring, presence of esophageal motor disorders, and endoscopy results were collected. Patients were classified as unproven and proven GERD, E-DGBI alone, refractory GERD, and overlap between GERD and E-DGBI. Questionnaires were obtained for reflux symptoms, presence of other DGBIs, levels of anxiety and depression, and visceral sensitivity.RESULTS:A total of 119 patients were included. Among 46 patients with proven GERD, 13 (28%) had isolated refractory GERD and 33 (72%) had an overlap of GERD and E-DGBIs. Among the unproven GERD group, 23 (31.5%) had GERD and 50 (68.5%) had an E-DGBI. Functional dyspepsia (70.6%) and irritable bowel syndrome (33.6%) were highly prevalent. No difference was found in symptom presentation, anxiety, depression, and visceral sensitivity scores. A higher acid exposure time and number of reflux episodes were found in patients with confirmed refractory GERD compared with the overlap E-DGBI-GERD group.DISCUSSION:E-DGBIs are highly prevalent in patients with proven GERD and refractory reflux symptoms. Studies with outcome data are needed to determine whether patients with overlapping E-DGBIs and GERD should be identified with pH-impedance monitoring on PPI therapy before an interventional treatment option is considered.