Investigation of gastric motility in patients with the overlap syndrome of the gastroesophageal reflux disease and functional dyspepsia

Rationale:  The phenomenon of overlap  of two disorders, non-erosive gastroesophageal reflux disease (NERD) and functional dyspepsia (FD) is an important clinical problem,  while the  symptoms in such  patients  are  more  severe  and  prevalent than  in those  with non-overlapping NERD or FD. This phenomenon may lead to treatment failure, if therapy  does not take into account  the specific pathophysiological mechanisms  of the NERD and FD overlap.

Aim: To study motility of the proximal and  distal parts  of the  stomach  in patients  with the overlap syndrome of NERD with FD.

Materials and  methods:  The  study  enrolled  56  patients (34 women and 22 men), aged from 18 to 45 years, who met the diagnostic  criteria for NERD and FD (the Rome criteria III, esophageal endoscopy, 24-hour  pH  measurement  or  24-hour  impedance pH measurement), and  had  both  NERD  and  FD symptoms  simultaneously  (overlap); 46 healthy volunteers. The accommodation of the  proximal (fundal) part  of the  stomach  and  motility of the distal gastric part  was assessed  by ultrasonography (Aixplorer, SuperSonic Imagine, France, with convex probe  1–6 MHz) before  and  after the  intake of the liquid test food. The patients  filled in questionnaires to assess the symptoms  and their severity (scored from 0 to 3). The difference  between their mean ± standard  deviation (SD) values was assessed  by Students  t-test  and  was considered  significant at p < 0.05.

Results: After intake of the  liquid test  food, the  patients  with the  FD and NERD overlap syndrome demonstrated an advanced and statistically significant gastric motility abnormality  both  in its proximal and distal parts, compared to healthy control: accommodation disturbances and its reduction, decreased amplitude  (61.4 ± 7.5 vs 90.2 ± 6.9%, p < 0.05), frequency of contractions of the antrum during 3-minute interval (4.3 ± 1.5 vs 9.7 ± 1.4, p < 0.05), antral motility index (4.3 ± 1.4 vs 8.8 ± 1.3%, p < 0.05), and gastric emptying   (37.1 ± 14.5   vs  69.1 ± 19.5%,  p < 0.05). Gastric accommodation abnormalities  were associated with a statistically significant increase in the severity  of the  following  symptoms: abdominal distention, postprandial feeling of fullness, early satiety, eructation, and heartburn (р< 0.05 for all symptoms).

Conclusion: Detection  of gastric accommodation and evacuation  abnormalities  that determine the  overlap  syndrome,  indicate  some common  mechanisms  of pathophysiology of FD and NERD, which should be taken into account for therapy optimization.