title: Clinical, metabolic, and psychological characteristics in patients with gastroesophageal reflux disease overlap with irritable bowel syndrome.
abstract: OBJECTIVE
  Gastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS) are highly prevalent in the general population, with significant symptom overlap, whereas the interaction between both remains poorly understood. We aim to identify the clinical and psychological factors that contribute toward the overlap of GERD and IBS.
  
  
  METHODS
  We carried out a case-control study among 806 GERD and 176 IBS patients from a health check-up cohort (n=2604). All participants were evaluated using the Reflux Disease Questionnaire score, the Pittsburgh Sleep Quality Index score, the Taiwanese Depression Questionnaire score, and the State-Trait Anxiety Inventory score. Endoscopic findings were classified according to the Los Angeles classification. IBS was diagnosed on the basis of Rome III criteria, and metabolic syndrome was defined by the National Cholesterol Education Program Adult Treatment Panel III definition.
  
  
  RESULTS
  Among the study population, 727 individuals had GERD, 97 individuals had IBS, and 79 individuals had a diagnosis of both GERD and IBS (GERD-I). GERD-I patients had more severe GERD symptoms compared with patients with GERD or IBS alone (P<0.0001). Moreover, GERD-I patients had more frequent healthcare-seeking behavior, decreased quality of sleep, and higher depression scores than patients with GERD (P<0.0001) or IBS alone (P<0.05). In addition, GERD-I patients had lower blood pressure, waist-to-hip ratio, and higher serum high-density lipoprotein levels than those with GERD alone (P<0.05).
  
  
  CONCLUSIONS
  GERD patients overlapping with IBS have different clinical and psychological profiles than those with GERD or IBS alone. Our study suggests that awareness of these symptom presentations will help optimize the treatment of these conditions.
authors.affiliation: aDepartment of Internal Medicine, Division of Gastroenterology, Taipei Tzu Chi Hospital bDepartment of Internal Medicine, Division of Gastroenterology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei cSchool of Medicine dDepartment of Public Health, College of Medicine, Tzu Chi University, Hualien, Taiwan, ROC eLynn Institute for Healthcare Research, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA fDivision of Gastroenterology, Department of Clinical Sciences, L. Sacco University Hospital, Milano, Italy.
authors.forename: Ching-Sheng
authors.initials: CS
authors.lastname: Hsu
authors.forename: Tso-Tsai
authors.initials: TT
authors.lastname: Liu
authors.forename: Shu-Hui
authors.initials: SH
authors.lastname: Wen
authors.forename: Chia-Chi
authors.initials: CC
authors.lastname: Wang
authors.forename: Chih-Hsun
authors.initials: CH
authors.lastname: Yi
authors.forename: Jiann-Hwa
authors.initials: JH
authors.lastname: Chen
authors.forename: Wei-Yi
authors.initials: WY
authors.lastname: Lei
authors.forename: William C
authors.initials: WC
authors.lastname: Orr
authors.forename: Pace
authors.initials: P
authors.lastname: Fabio
authors.forename: Chien-Lin
authors.initials: CL
authors.lastname: Chen
mesh_terms: D000328:Adult; D001794:Blood Pressure; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D003863:Depression / Q000209:etiology; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005764:Gastroesophageal Reflux / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology*; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology*; D008075:Lipoproteins, HDL / Q000097:blood; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D020919:Sleep Disorders, Intrinsic / Q000209:etiology; D011795:Surveys and Questionnaires; D049629:Waist-Hip Ratio
chemical_list: D008075:Lipoproteins, HDL