A subset of functional dyspepsia patients respond to acid suppressive therapy.
However, the prevalence of non-erosive reflux disease in functional dyspepsia and its relevance to symptoms have never been established.
Dr Tack and colleagues from Belgium studied 24 hour pH monitoring in consecutive functional dyspepsia patients.
A total of 247 patients with dyspeptic symptoms participated in the study, of which 166 were women with a mean age 44.
The patients had a negative upper gastrointestinal endoscopy and without dominant symptoms of heartburn.
|76% with a positive heartburn questionnaire had pathological pH monitoring|
In all patients, the severity of dyspeptic symptoms and the presence of heartburn was assessed by a questionnaire.
The researchers performed a 24 hour esophageal pH monitoring study in all patients.
All patients underwent a gastric emptying breath test and in 113 the team performed a gastric barostat study.
The researchers found that abnormal pH monitoring, defined as acid exposure more than 5% of time, was found in 23% of patients.
Of 21 patients with a positive heartburn questionnaire, 76% had pathological pH monitoring.
The team noted that only 19% of patients with a negative heartburn questionnaire had pathological pH monitoring.
The researchers observed that demographic characteristics did not differ between heartburn negative patients with normal or abnormal acid exposure.
The prevalence of other pathophysiological mechanisms did not differ between heartburn negative patients with normal or abnormal acid exposure.
The team found that pathological acid exposure in heartburn negative patients was associated with the presence of epigastric pain.
In addition, pathological acid exposure in heartburn negative patients was associated with moderate or severe pain.
Dr Tack's team concluded, “Pathological esophageal acid exposure is only present in a subset of heartburn negative functional dyspepsia patients, which are characterized by a higher prevalence of epigastric pain.”