Overlap Functional GI Disorders: FD-GERD (Epigastric Pain, Postprandial Fullness, Belching & Acid Eructation)

Hidekazu Suzuki, MD, PhD, FACG, AGAF, RFF, FJGES.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan, on behalf of APAGE working team on Guidelines for Management of Functional Dyspepsia Overlap

About one third of patients qualifying for Rome criteria for functional dyspepsia (FD), but without the typical reflux symptoms of heartburn and acid regurgitation were found on 24-hour ambulatory esophageal pH monitoring to have pathologic acid reflux, with epigastric burning sensation. The putative pathophysiology of this FD-GERD overlap may include impaired gastric accommodation with transient lower esophageal sphincter relaxations (TLESRs), duodenal eosinophilia and duodenal hypersensitivity. Then, possible treatment options may include histamine H1/H2 receptor blockade, anti-secretory agents such as PPI or P-CAB, neuromodulators such as tricyclic agent and fundus relaxant such as baclofen, acotiamide, etc.