Insights into gastroesophageal reflux disease-associated dyspeptic symptoms

Background & Aims: Patients with GERD frequently report dyspeptic-like symptoms, including nausea, vomiting, early satiety, bloating, and belching. The purpose of this review was to define the epidemiology and underlying mechanisms for dyspeptic symptoms in GERD patients. Methods: We performed a systematic literature review to identify the prevalence of dyspeptic symptoms in GERD patients. We identified 2057 studies, and 37 studies (2%) met the entry criteria, including 17 articles describing the prevalence of dyspeptic symptoms in GERD subjects, 7 studies describing mechanistic evaluation of dyspeptic symptoms in GERD, 7 studies describing questionnaires used to measure dyspeptic symptoms, and 6 studies assessing the role of proton pump inhibitor therapy for dyspeptic symptoms associated with GERD. We used an evidence-based approach to assess the literature. Results: The median (± standard deviation) prevalence of GERD in 30,384 subjects from 8 studies conducted in Western countries was 30% ± 8% (range, 20%-40%). Dyspeptic symptoms were present in 38% ± 14% (range, 21%-63%) and were more frequent in patients with frequent GERD symptoms, compared with patients with intermittent or no GERD symptoms [Evidence B]. Patients with nonerosive disease had a higher prevalence of dyspeptic symptoms [Evidence B] in addition to a lower response to proton pump inhibitor therapy [Evidence A], compared with patients with erosive esophagitis. Epigastic pain, belching, bloating, and early satiety demonstrated improvement on PPI therapy [Evidence A], compared with symptoms of nausea and vomiting that did not improve [Evidence A]. Patients with dyspepsia were at risk for a subsequent new diagnosis of GERD [Evidence B]. Dyspeptic symptoms contributed significantly to the decrement in health-related quality of life associated with GERD. Conclusions: Dyspeptic symptoms are common in GERD patients and impact health-related quality of life.