Dig Liver Dis 2025 Oct 24; doi: 10.1016/j.dld.2025.10.008.

Epigastric pain syndrome overlaps with gastroesophageal reflux disease, while postprandial distress syndrome with esophageal disorders of gut-brain interaction.

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BACKGROUND: Functional dyspepsia (FD) and gastroesophageal reflux disease (GERD) frequently coexist. Studies suggest that patients with the Epigastric Pain Syndrome (EPS) subtype of FD have higher esophageal acid exposure and respond better to proton pump inhibitors (PPIs) than those with Postprandial Distress Syndrome (PDS). AIM: To evaluate multichannel intraluminal impedance-pH (MII-pH) monitoring findings in FD patients and assess potential overlap with GERD and esophageal disorders of gut-brain interaction (DGBI). METHODS: Patients fulfilling Rome IV criteria for EPS and PDS, both with and without suspected GERD overlap, underwent MII-pH monitoring. Parameters assessed included esophageal acid exposure time, reflux episodes (acid and non-acid), and symptom association probability. GERD was diagnosed using Lyon 2.0 criteria; esophageal DGBI were evaluated according to Rome IV. RESULTS: A total of 100 patients were included: 40 with FD (20 EPS, 20 PDS), 40 with FD and potential GERD overlap (20 EPS, 20 PDS), and 20 with conclusive GERD. Mean nocturnal baseline impedance (MNBI) declined progressively across groups, from PDS (2637.5 ohms) to GERD (828 ohms) (p < 0.01). Esophageal DGBI were more prevalent in PDS than EPS among patients with GERD symptoms (55 % vs 20 %, p = 0.02). CONCLUSIONS: EPS is more strongly associated with GERD, while PDS more frequently overlaps with esophageal DGBI.

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