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GERS associated with increased odds of coexistent dyspepsia

03 Sep 2017

Gastro-oesophageal reflux symptoms (GERS) carry a sevenfold increased likelihood of coexistent dyspepsia, with the two conditions overlapping in more than 25 percent of individuals, according to a meta-analysis.

Researchers searched multiple electronic databases for studies reporting the prevalence of dyspepsia and GERS in adults (defined using specific symptom-based criteria or based on answers to questionnaires) and identified 365 relevant papers. Of these, 79 reported the prevalence of weekly GERS in an adult population, including 19 (n=111,459) that also related the proportion of individuals with dyspepsia.

Pooled data showed that the prevalence of dyspepsia was 43.9 percent in individuals with weekly GERS. Individuals with weekly GERS were nearly seven times as likely as those without GERS to have dyspepsia (odds ratio, 6.94; 95 percent CI, 4.33 to 11.1). The increased odds of dyspepsia in individuals with weekly GERS persisted across all geographical regions studied and for all diagnostic criteria.

Furthermore, the degree of overlap between GERS and dyspepsia was 25.9 percent (19.9 to 32.4).

While remaining speculative, reasons for the increased odds of having concomitant dyspepsia in patients with GERS may involve shared pathophysiological mechanisms or residual confounding factors, researchers said.

Patients with GERS should thus be examined for coexistent dyspepsia to optimize treatment approaches, they added.

Gastro-oesophageal reflux refers to the backflow of stomach contents into the oesophagus, with typical symptoms including heartburn, regurgitation and chest pain. The pathogenesis of GERS may include oesophageal pressure abnormalities, lower oesophageal sphincter relaxation, hiatus hernia, delayed gastric emptying and visceral hypersensitivity. [Gut 2017;doi:10.1136/gutjnl-2016-313589; Surg Clin North Am 2015;95:515-25]

Dyspepsia, on the other hand, entails any symptom felt to originate from the gastroduodenal region. Potential mechanisms for this condition may involve visceral sensitivity and delayed gastric emptying—both common to GERS—as well as impaired fundal accommodation, abnormal central pain processing, acute gastroenteritis and chronic infection with Helicobacter pylori. [Gastroenterology 2006;130:1466-79; Neurogastroenterol Motil 2006;18:894-904; Gastroenterology 2007;132:1684-93]

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Elvira Manzano, 3 days ago
Bisphosphonates have proven antifracture efficacy and remain to be the cornerstone of osteoporosis treatment. However, a drug holiday is of particular importance with bisphosphonates due to some signals with long-term use of the drug, including rare incidence of atypical femoral fracture (AFF) and osteonecrosis of the jaw (ONJ), says a leading endocrinologist at AFOS 2017.
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