Investigation of gastric motility in patients with the overlap syndrome of the gastroesophageal reflux disease and functional dyspepsia

Abstract

Rationale: The phenomenon of overlap of two disorders, non-erosive gastroesophageal reflux disease (NERD) and functional dyspepsia (FD) is an important clinical problem, while the symptoms in such patients are more severe and prevalent than in those with non-overlapping NERD or FD. This phenomenon may lead to treatment failure, if therapy does not take into account the specific pathophysiological mechanisms of the NERD and FD overlap.Aim: To study motility of the proximal and distal parts of the stomach in patients with the overlap syndrome of NERD with FD.Materials and methods: The study enrolled 56 patients (34 women and 22 men), aged from 18 to 45 years, who met the diagnostic criteria for NERD and FD (the Rome criteria III, esophageal endoscopy, 24-hour pH measurement or 24-hour impedance pH measurement), and had both NERD and FD symptoms simultaneously (overlap); 46 healthy volunteers. The accommodation of the proximal (fundal) part of the stomach and motility of the distal gastric part was assessed by ultrasonography (Aixplorer, SuperSonic Imagine, France, with convex probe 1–6 MHz) before and after the intake of the liquid test food. The patients filled in questionnaires to assess the symptoms and their severity (scored from 0 to 3). The difference between their mean ± standard deviation (SD) values was assessed by Students t-test and was considered significant at p < 0.05.Results: After intake of the liquid test food, the patients with the FD and NERD overlap syndrome demonstrated an advanced and statistically significant gastric motility abnormality both in its proximal and distal parts, compared to healthy control: accommodation disturbances and its reduction, decreased amplitude (61.4 ± 7.5 vs 90.2 ± 6.9%, p < 0.05), frequency of contractions of the antrum during 3-minute interval (4.3 ± 1.5 vs 9.7 ± 1.4, p < 0.05), antral motility index (4.3 ± 1.4 vs 8.8 ± 1.3%, p < 0.05), and gastric emptying (37.1 ± 14.5 vs 69.1 ± 19.5%, p < 0.05). Gastric accommodation abnormalities were associated with a statistically significant increase in the severity of the following symptoms: abdominal distention, postprandial feeling of fullness, early satiety, eructation, and heartburn (р< 0.05 for all symptoms).Conclusion: Detection of gastric accommodation and evacuation abnormalities that determine the overlap syndrome, indicate some common mechanisms of pathophysiology of FD and NERD, which should be taken into account for therapy optimization.

Keywords

• overlap syndrome of functional dyspepsia with non-erosive reflux disease
• gastric motility abnormalities
• gastric accommodation
• gastric emptying