Overlap of esophageal disorders of gut-brain interactions (E-DGBIs) and GERD is highly prevalent in patients with refractory reflux symptoms

Background: Esophageal disorders of gut-brain interaction (E-DGBIs) are highly prevalent in patients with unproven gastro-esophageal reflux disease (GERD) who do not respond to proton pump inhibitors (PPIs). The aim of this study was to determine the prevalence and characteristics of confirmed refractory GERD and E-DGBIs in consecutive patients with refractory reflux symptoms. Patients and methods: Patients with typical refractory reflux symptoms were prospectively enrolled. Data on age, gender, primary symptoms, pH and pH-impedance monitoring data, presence of esophageal motor disorders and endoscopy results were collected. Patients were classified as unproven and proven GERD, e-DGBI alone, refractory GERD and overlap between GERD and E-DGBI. Questionnaires were obtained for reflux symptoms, presence of other DGBIs, levels of anxiety and depression and on visceral sensitivity Results: A total of 119 patients were included. Among 46 proven GERD patients, 13 (28%) had isolated refractory GERD and 33 (72%) had an overlap of GERD and E-DGBIs. Among unproven GERD group, 23 (31.5%) had GERD and 50 (68.5%) had an E-DGBI. Functional dyspepsia (70.6%) and irritable bowel syndrome (33.6%) were highly prevalent. No difference was found in symptom presentation, anxiety, depression and visceral sensitivity scores. A higher acid exposure time and number of reflux episodes were found in patients with confirmed refractory GERD compared to overlap E-DGBI-GERD group. Conclusion: E-DGBIs are highly prevalent in patients with proven GERD and refractory reflux symptoms. Studies with outcome data are needed to determine whether patients with overlapping E-DGBIs and GERD should be identified with pH-impedance monitoring on PPI therapy before an interventional treatment option is considered.