Factors Associated With Overlap Between Functional Bowel Disorders And Gastroesophageal Reflux Disease

Background:Functional bowel disorders (FBDs) and gastroesophageal reflux disease (GERD) are common gastrointestinal disorders in the adult population. A few of studies have investigated the overlap between irritable bowel syndrome (IBS) and GERD that occurred quite often. However, limited data published about overlap between FBDs and GERD, and factors associated with such overlap are unclarified.Aim:This study was conducted to determine prevalence and factors associated with overlap of FBDs and GERD.Methods:From September,2008to June,2010, a cross-sectional survey was performed on304outpatients who had lower gastrointestinal symptoms and underwent the upper endoscopy. FBDs were assessed according to the Rome Ⅲ criteria. GERD is defined as a disorder in which gastric contents reflux recurrently into the esophagus, causing troublesome symptoms and/or complications, which included reflux esophagitis (RE) and non-erosive reflux disease (NERD). RE was defined as endoscopic esophageal mucosal break with or without typical symptoms of GERD according to the Los Angeles classification. NERD was defined as having typical heartburn at least once a week without visible esophageal mucosal break on endoscopy. The healthy volunteers were randomly recruited patients without severe gastrointestinal symptoms, and the subjects who had GERD, FGIDs and organic diseases were excluded.The subjects were questionaired about demographic data, medical history, smoking, alcohol use, gastrointestinal symptoms (using gastrointestinal symptom questionnaire), anxiety and depression (using the Hospital Anxiety and Depression Scale), and latest life events (using the Life Events Survey) at the start of the study. All data were analyzed by SPSS18.0software package, P≤0.05was considered as statistical significance.Results:304outpatients who had lower gastrointestinal symptoms underwent the upper endoscopy. Among the131subjects who were diagnosed as FBDs according to Rome III criteria,28(21.4%) FBDs outpatients had GERD. Compared with the healthy volunteers, both FBDs overlap and FBDs alone had higher LES score [90.5(0.0-361.0) vs.17.0(0.0-212.0);56.0(0.0-363.0) vs.17.0(0.0-212.0), P＜05] and anxiety score (6.9±4.1vs.2.6±2.7;5.0±4.2vs.2.6±2.7, P＜0.05). Compared with the healthy volunteers, FBDs overlap had higher depression score(6.9±4.3vs.4.0±3.9, P＜0.05), while the difference between FBDs alone and the healthy volunteers had no statistical significance(5.0±4.2vs.4.0±3.9, P>0.05). Compared with FBDs alone, FBDs overlap had higher LES score[90.5(0.0-361.0) vs.56.0(0.0-363.0), P＜0.05], anxiety score(6.9±4.1vs.5.0±4.2, P＜0.05) and depression score(6.9±4.3vs.5.0±3.8, P＜0.05). Severe latest life events (OR3.9,95%CI1.0-14.2), anxiety (OR2.0,95%CI1.0-5.6) and depression (OR2.3,95%CI1.0-5.5) were significantly associated with FBDs overlap, compared with FBDs alone(P≤0.05).Compared with the healthy volunteers, both FBDs overlap and FBDs alone had higher proportion of marriage(89.3%vs.62.5%;87.4%vs.62.5%, P＜0.05), while the differences of sex, age, smoking, alcohol use and the degree of gastrointestinal symptoms had no statistical significance(P>0.05). The differences of sex, age, marriage, smoking, alcohol use and the degree of gastrointestinal symptoms between FBDs overlap and FBDs alone had no statistical significance(P>0.05). According to multiple regression analysis, sex, age, marriage, education level, smoking, alcohol use frequency of abdominal pain or discomfort, frequency of abdominal bloating, and the degree of gastrointestinal symptoms were not risk factors associated with FBDs overlap, compared with FBDs alone(P>0.05).Conclusions:FBDs and GERD overlap is common in the outpatients. These overlaps occur predominantly in individuals with severe latest life events and, anxiety and depression.