Bowel symptoms in nonerosive gastroesophageal reflux disease: nature, prevalence, and relation to acid reflux

J Clin Gastroenterol. 2008 Mar;42(3):261-5. doi: 10.1097/MCG.0b013e31802fc591.

Abstract

Background: Nonerosive gastroesophageal reflux disease (NERD) patients frequently show features of the irritable bowel syndrome (IBS).

Aims: To investigate the prevalence and intensity of bowel symptoms and their relationship to esophageal acid exposure in NERD patients.

Methods: Bowel and reflux symptoms and IBS status were assessed in NERD patients (normal upper endoscopy; esophageal pH <4 for >or= 5% of the time on 24-h pH monitoring; n=326), in relation to nonpatient controls. Bowel symptoms were scored on the 3 scales: diarrhea, constipation, and pain/gas symptoms.

Results: NERD and age were independently associated with bowel symptoms. NERD patients scored significantly higher than controls on all bowel scales. In a multivariate analysis, the scores on the pain/gas scale were independently associated with NERD. In NERD patients, reflux symptoms independently predicted the bowel symptoms while acid exposure did not. Forty-nine percent of the NERD patients and 18% of the controls met the criteria for IBS [IBS(+)NERD]. IBS(+)NERD patients scored significantly higher than those not meeting IBS criteria [IBS(-)] on all bowel scales. Yet IBS(-) patients scored significantly higher than controls on the scales of constipation and pain/gas. IBS(+)NERD patients scored higher than IBS(-) also on the GERD symptoms scale.

Conclusions: (1) NERD patients scored significantly higher than controls on all the bowel scales; (2) Bowel symptoms were associated with reflux symptom scores, but not with acid exposure. (3) The presence of IBS features in a large proportion of NERD patients reflects a high prevalence of visceral hypersensitivity that may aggravate acid reflux symptoms.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Case-Control Studies
  • Endoscopy, Gastrointestinal
  • Esophageal pH Monitoring
  • Female
  • Follow-Up Studies
  • Gastric Acid / metabolism
  • Gastroesophageal Reflux / complications*
  • Gastroesophageal Reflux / diagnosis
  • Gastroesophageal Reflux / metabolism
  • Humans
  • Irritable Bowel Syndrome / diagnosis
  • Irritable Bowel Syndrome / epidemiology
  • Irritable Bowel Syndrome / etiology*
  • Israel / epidemiology
  • Male
  • Prevalence
  • Prospective Studies
  • Risk Factors
  • Surveys and Questionnaires