title: Overlap of Dyspepsia in Patients with Gastroesophageal Reflux Disease: Impact of Clinical, Metabolic, and Psychosocial Characteristics.
abstract: 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.
authors.affiliation: 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.|School of Medicine, Tzu Chi University, Hualien, Taiwan, ROC.
authors.forename: Ching-Sheng
authors.initials: CS
authors.lastname: Hsu
authors.affiliation: Department of Public Health, College of Medicine, Tzu Chi University, Hualien, Taiwan, ROC.
authors.forename: Shu-Hui
authors.initials: SH
authors.lastname: Wen
authors.affiliation: School of Medicine, Tzu Chi University, Hualien, Taiwan, ROC.|Division of Gastroenterology, Department of Internal Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 707, Sec. 3, Chung Yang Rd., Hualien, 970, Taiwan, ROC.
authors.forename: Jui-Sheng
authors.initials: JS
authors.lastname: Hung
authors.affiliation: School of Medicine, Tzu Chi University, Hualien, Taiwan, ROC.|Division of Gastroenterology, Department of Internal Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 707, Sec. 3, Chung Yang Rd., Hualien, 970, Taiwan, ROC.
authors.forename: Tso-Tsai
authors.initials: TT
authors.lastname: Liu
authors.affiliation: School of Medicine, Tzu Chi University, Hualien, Taiwan, ROC.|Division of Gastroenterology, Department of Internal Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 707, Sec. 3, Chung Yang Rd., Hualien, 970, Taiwan, ROC.
authors.forename: Chih-Hsun
authors.initials: CH
authors.lastname: Yi
authors.affiliation: School of Medicine, Tzu Chi University, Hualien, Taiwan, ROC.|Division of Gastroenterology, Department of Internal Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 707, Sec. 3, Chung Yang Rd., Hualien, 970, Taiwan, ROC.
authors.forename: Wei-Yi
authors.initials: WY
authors.lastname: Lei
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, ASST Bergamo Est, "Bolognini" Hospital, Seriate, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Pace
authors.affiliation: School of Medicine, Tzu Chi University, Hualien, Taiwan, ROC. harry.clchen@msa.hinet.net.|Division of Gastroenterology, Department of Internal Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 707, Sec. 3, Chung Yang Rd., Hualien, 970, Taiwan, ROC. harry.clchen@msa.hinet.net.
authors.forename: Chien-Lin
authors.initials: CL
authors.lastname: Chen
mesh_terms: D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004415:Dyspepsia / Q000175:diagnosis* / Q000378:metabolism* / Q000523:psychology; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000378:metabolism* / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires
keywords: Cross-sectional study; Dyspepsia; Humans; Questionnaires