Prevalence of Overlapping Esophageal DGBIs and GERD in Patients With Refractory Reflux
A prospective study published in The American Journal of Gastroenterology found that a substantial majority of patients with confirmed gastroesophageal reflux disease (GERD) and refractory symptoms also exhibited esophageal disorders of gut-brain interaction (E-DGBIs).
Researchers investigated the prevalence and characteristics of E-DGBIs in patients with refractory reflux symptoms, including those with confirmed GERD. The study enrolled 119 patients with persistent reflux symptoms, despite treatment with proton pump inhibitor (PPI) therapy. Comprehensive clinical, endoscopic, and motility assessments were performed alongside validated questionnaires addressing symptom burden, psychological comorbidities, and visceral sensitivity.
Among the 46 patients with objectively confirmed GERD, 72% (n=33) had overlapping E-DGBI diagnoses, while only 28% (n=13) had isolated refractory GERD. In the cohort of 73 patients with unproven GERD, E-DGBIs were identified in 68.5% (n=50), while 31.5% (n=23) were diagnosed with GERD. Functional dyspepsia and irritable bowel syndrome were also frequently observed, at 70.6% and 33.6%, respectively.
Although the overlap group and isolated GERD patients exhibited similar symptom profiles and psychological metrics for anxiety, depression, and visceral sensitivity, those with confirmed refractory GERD had significantly greater acid exposure and reflux episodes. This suggests that symptom severity alone may not reliably differentiate between GERD and overlapping E-DGBIs.
These findings underscore the diagnostic complexity of refractory reflux and the importance of esophageal pH-impedance monitoring even during PPI therapy to discern overlapping pathophysiologies. The authors advocate for outcome-based studies to determine whether intervention strategies should be tailored when both GERD and E-DGBIs coexist.
Reference
Caldart F, Gabriel C, Vauquelin B, Rivière P, Berger A, Zerbib F. Overlap of esophageal disorders of gut-brain interactions and gastroesophageal reflux disease is highly prevalent in patients with refractory reflux symptoms. Am J Gastroenterol. 2025;120(8):1770-1778. doi:10.14309/ajg.0000000000003542
