Prevalence and Symptom Pattern of Pathologic Esophageal Acid Reflux in Patients With Functional Dyspepsia Based on the Rome III Criteria

OBJECTIVES: To determine the prevalence and symptom pattern of pathologic esophageal acid reflux (PEAR) in patients with functional dyspepsia (FD) using the Rome III criteria, and to explore the value of a proton pump inhibitor (PPI) test in distinguishing the patients with and those without PEAR among FD patients. METHODS: Consecutive FD patients who fulfilled the Rome III criteria without predominant typical reflux symptoms (i.e., heartburn or regurgitation) were enrolled. All patients underwent upper endoscopy and an ambulatory 24-h pH monitoring. PEAR was defined as the percentage total time for which a pH value <4 was >4.2% in the distal esophagus. Then, patients were treated with rabeprazole 10 mg twice daily for 28 days. The symptom scores were measured by the frequency score multiplied by the severity scores of the predominant symptom before and at the end of the treatment, and the PPI test was defined as positive if the overall scores of the predominant dyspeptic symptom in the fourth week decreased by >50% compared with those of the baseline. RESULTS: One hundred eighty-six FD patients were enrolled, with predominant symptoms of epigastric pain (n = 68), epigastric burning (n = 47), bothersome postprandial fullness (n = 54), and early satiation (n = 17). The prevalence of PEAR was 31.7%, with the highest percentage (48.9%) in patients with epigastric burning as their predominant symptom. The prevalence of PEAR in patients with postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS) were 36.6% (26/71) and 28.7% (33/115), respectively. Overall, 63.4% were positive for the PPI test; the rates were 51.5, 85.0, 66.7, and 41.1% in patients with epigastric pain, epigastric burning, bothersome postprandial fullness, and early satiation as their predominant symptoms, respectively (chi(2) = 17.59, P = 0.001). The positive rates were 65.5 and 60.6% in patients with PDS and EPS, respectively (chi(2) = 0.41, P = 0.522). The sensitivity and specificity of the PPI test in distinguishing FD patients with PEAR was 83.1 and 45.7%, respectively. CONCLUSIONS: PEAR is present in almost one third of FD patients; the prevalence is similar to 50% in those with epigastric burning. The PPI test has a limited value in distinguishing the FD patients with and those without PEAR.