Distinguishing functional dyspepsia from NERD

Careful investigation can distinguish patients with functional dyspepsia from those with non-erosive reflux disease, and spare them unnecessary acid-suppressing therapy or even surgery, a new study has concluded. Italian researchers examined 200 patients with typical reflux symptoms and normal endoscopy. There were 41% who had an abnormally high acid exposure time in the oesophagus, based on 24-hour pH monitoring, which explained the typical symptoms of heartburn and regurgitation. Another 32% had normal acid exposure and typical symptoms when the exposure occurred. They were classified as having a ‘hypersensitive oesophagus’. The remaining 27% had normal acid exposure but no symptoms related directly to the exposure. This group, classified as having functional dyspepsia, tended to have other symptoms extending beyond the oesophagus including postprandial fullness, bloating, early satiety and nausea. Distinguishing functional dyspepsia “should spare these patients from wasteful and protracted courses of years of acid suppression and, above all, prevent potentially disastrous exposure to surgical options,” the researchers said. Reflux disease was one of the most common gastrointestinal diseases in Western societies, the authors noted, but about 70% of patients with typical symptoms had no visible oesophageal injuries on endoscopy. However, this large group of patients with non-erosive disease probably had a wider range of conditions than previously acknowledged, they concluded. Gut published online....