ASSOCIATION OF IRRITABLE BOWEL SYNDROME WITH NON-EROSIVE REFLUX DISEASE

Background and aim: Irritable Bowel Syndrome (IBS) and Gastroesophageal Reflux Disease (GERD) are very common disorders in the general population. Symptoms of IBS are commonly encountered in GERD patients, and symptoms of GERD are not uncommon in IBS pts. In our study we evaluated the prevalence of Erosive Reflux Disease (ERD) and Non-erosive Reflux Disease (NERD) in IBS pts and their relationship with IBS subtype. Material and methods:From November 2010 to October 2011 we examinated 542 consecutive pts (28.3% M and 71.7% F; mean age: 47.0 yrs; range 15-84 yrs) referring to our ambulatory of gastrointestinal disease. Three hundred and eleven pts (311/542) had GERD and/or IBS symptoms (according to Rome III criteria). We divided these pts in three groups: IBS-only (n=126), GERD-only (n=66) and IBS plus GERD (n=119). IBS pts, with or without GERD were subdivided in other three groups: IBS with constipation (IBS-C, n=80), IBS with diarrhea (IBS-D, n=80) and IBS with alternating C/D (IBS-CD, n=85). GERD pts with or without IBS, were diagnosed with ERD (n=61) or NERD (n=124) by endoscopic examination. Statistical analysis was performed with Chi-square test. Results:The comparative analysis between GERD-only pts (37 NERD, 29 ERD) and IBS-GERD pts (87 NERD, 32 ERD) evidenced a positive correlation among these disease (Odds Ratio = 3,30, 95% CI: 2,28–4,79; P<0.05).We didn’t find any positive relationship between presence of GERD and bowel habit analysing the subgroups division of IBS-only pts (IBS-C= 37, IBS-D = 45, IBS-CD = 44) and IBS-GERD pts (IBS-C = 43, IBS-D = 35, IBS-CD = 41). In particular, ERD and NERD had a negative relationship with IBS onset (ERD: OR=1,05, 95% CI: 0,63–1,75, P=ns; NERD: OR=5,08, 95% CI: 3,19– 8,09, P=ns). Furthermore, from our data we observed a closed association between NERD and IBS-CD (OR=1,92, 95% CI: 1,15–3,21). Conclusions:These results show an overlap of GERD in a 48.6% of IBS pts. This association could be explained admitting the existence of a common functional starting problem or, as confirmed by studies, an improvement of IBS-like symptoms in patients with reflux disease receiving anti-reflux treatment. Furthermore, the relationship between NERD and IBS-CD, suggests a common functional disorder of smooth muscles or sensory afferents.