Hsu Ching-Sheng, Wen Shu-Hui, Hung Jui-Sheng, Liu Tso-Tsai, Yi Chih-Hsun, Lei Wei-Yi, Pace Fabio, Chen Chien-Lin
Division of Gastroenterology, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan, ROC.
School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan, ROC.
Dig Dis Sci. 2017 Apr;62(4):994-1001. doi: 10.1007/s10620-017-4455-8. Epub 2017 Jan 23.
Gastroesophageal reflux disease (GERD) and dyspepsia are highly prevalent in the general population with significant symptom overlap, while the interaction between both remains poorly understood.
To examine whether GERD overlapping dyspepsia would have an impact on clinical and psychological features as compared with GERD alone.
We performed a cross-sectional study in a GERD cohort (n = 868) that was previously recruited from a population-based GERD survey (n = 2752). We compared the clinical and psychological factors between patients with and without dyspeptic symptoms "epigastric pain or burning." All participants were evaluated with Reflux Disease Questionnaire score, Pittsburgh Sleep Quality Index score, Taiwanese Depression Questionnaire score, and State-Trait Anxiety Inventory score. Endoscopic findings were classified according to the Los Angeles classification.
Among the GERD population, 107 subjects had overlapping "epigastric pain or burning" (GERD-D), and 761 did not have these symptoms (GERD alone). GERD-D subjects had more severe GERD symptoms and were more often associated with irritable bowel syndrome (IBS) (OR 3.54, 95% CI 1.92-6.52) as compared subjects with GERD alone. In addition, GERD-D subjects had lower quality of sleep (OR 1.11, 95% CI 1.01-1.21), higher depression (OR 1.06, 95% CI 1.02-1.10), lower blood pressure (OR 0.45, 95% CI 0.22-0.95), and higher serum total cholesterol levels (OR 2.78, 95% CI 1.36-5.67) than GERD alone.
GERD-D subjects are characterized with worsening clinical symptoms as well as higher psychosocial, IBS, and metabolic comorbidities, but less erosive esophagitis. Our results indicate that clinical awareness of such overlapping condition would help optimize the management of GERD in clinical practice.
胃食管反流病（GERD）和消化不良在普通人群中非常普遍，症状有显著重叠，但两者之间的相互作用仍知之甚少。
研究与单纯GERD相比，GERD合并消化不良是否会对临床和心理特征产生影响。
我们在一个GERD队列（n = 868）中进行了一项横断面研究，该队列先前是从一项基于人群的GERD调查（n = 2752）中招募的。我们比较了有和没有消化不良症状（上腹部疼痛或烧灼感）的患者之间的临床和心理因素。所有参与者均接受反流病问卷评分、匹兹堡睡眠质量指数评分、台湾抑郁问卷评分和状态-特质焦虑量表评分。内镜检查结果根据洛杉矶分类法进行分类。
在GERD人群中，107名受试者有重叠的“上腹部疼痛或烧灼感”（GERD-D），761名没有这些症状（单纯GERD）。与单纯GERD受试者相比，GERD-D受试者有更严重的GERD症状，且更常与肠易激综合征（IBS）相关（比值比3.54，95%置信区间1.92 - 6.52）。此外，GERD-D受试者的睡眠质量较低（比值比1.11，95%置信区间1.01 - 1.21），抑郁程度较高（比值比1.06，95%置信区间1.02 - 1.10），血压较低（比值比0.45，95%置信区间0.22 - 0.95），血清总胆固醇水平较高（比值比2.78，95%置信区间1.36 - 5.67）。
GERD-D受试者的特点是临床症状恶化，以及更高的心理社会、IBS和代谢合并症，但糜烂性食管炎较少。我们的结果表明，临床认识到这种重叠情况将有助于在临床实践中优化GERD的管理。
