The overlap between gastroesophageal reflux disease and irritable bowel syndrome: an updated systematic review

Bader Saad Alahmari, Yahya Mohammed Al Allush, Moyed Hamoud Almontasheri, Saad Ali Al Zulfah, Yahya Ali Al-Imamah, Mohammad Abdullah Al Mastoor, Nasser Ibraheem Alqahtani


Evidence shows that a degree of overlap is detected between gastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS). In this review, we aim to update the current evidence from recent studies published in the last decade. Electronic and manual search strategies were both conducted to look for studies that reported the association between gastroesophageal reflux disease and IBS from 2011 to January 2021. We have included all study designs to formulate updated evidence and report all the potential outcome measures. We included a total of 16 studies on a total of 146,156 patients, collectively. Out of these studies, 14 were cross-sectional while only two were randomized controlled trials. The frequency of overlap was hugely variable among the results of the included studies, ranging between 1.7 and 74.7%. Almost all studies used the Rome III criteria for IBS and used questionnaire-based assessment for gastroesophageal reflux disease patients. Female gender and cigarette smoking were the commonest most significant risk factors for developing the overlap. Intestinal hypersensitivity, hyperactive gastric acids, and generalized abnormal motility of the digestive tract were the commonest theories. Obtained evidence remains strong, indicating the overlap between IBS and gastroesophageal reflux disease patients, however, the definite explanation remains non-clear and further studies are needed.



GERD, Irritable bowel syndrome, Overlap, Epidemiology

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Drossman DA, Hasler WL. Rome IV-Functional GI Disorders: Disorders of Gut-Brain Interaction. Gastroenterology. 2016;150(6):1257-61.

Koloski NA, Talley NJ, Boyce PM. Epidemiology and health care seeking in the functional GI disorders: a population-based study. Am j gastroenterol. 2002;97(9):2290-9.

Koloski NA, Talley NJ, Boyce PM. The impact of functional gastrointestinal disorders on quality of life. Am j gastroenterol. 2000;95(1):67-71.

Vakil N, Van Zanten SV, Kahrilas P, Dent J, Jones R. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am j gastroenterol. 2006;101(8):1900-2043.

El-Serag HB, Sweet S, Winchester CC, Dent J. Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut. 2014;63(6):871-80.

Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am j gastroenterol. 2013;108(3):308-28.

Savarino E, Bredenoord AJ, Fox M, Pandolfino JE, Roman S, Gyawali CP. Expert consensus document: Advances in the physiological assessment and diagnosis of GERD. Nature reviews Gastroenterol hepatol. 2017;14(11):665-76.

Kennedy TM, Jones RH, Hungin AP, O'Flanagan H, Kelly P. Irritable bowel syndrome, gastro-oesophageal reflux, and bronchial hyper-responsiveness in the general population. Gut. 1998;43(6):770-4.

Jung HK, Halder S, McNally M. Overlap of gastro-oesophageal reflux disease and irritable bowel syndrome: prevalence and risk factors in the general population. Alimentary pharmacol therap. 2007;26(3):453-61.

Quigley EM, Lacy BE. Overlap of functional dyspepsia and GERD--diagnostic and treatment implications. Nature reviews Gastroenterol hepatol. 2013;10(3):175-86.

De Bortoli N, Tolone S, Frazzoni M. Gastroesophageal reflux disease, functional dyspepsia and irritable bowel syndrome: common overlapping gastrointestinal disorders. Ann Gastroenterol. 2018;31(6):639-48.

Liberati A, Altman DG, Tetzlaff J. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700.

Celikten B, Uzuntas CF, Kurt H. Multiple idiopathic external and internal resorption: Case report with cone-beam computed tomography findings. Imaging Sci Dent. 2014;44(4):315.

Higgins JPT, Altman DG, Gøtzsche PC. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.

Rasmussen S, Jensen TH, Henriksen SL. Overlap of symptoms of gastroesophageal reflux disease, dyspepsia and irritable bowel syndrome in the general population. Scandinavian j gastroenterol. 2015;50(2):162-9.

Pourhoseingholi A, Pourhoseingholi MA, Moghimi-Dehkordi B. Epidemiological features of gastro-esophageal reflux disease in Iran based on general population. Gastroenterol hepatol bed to bench. 2012;5(1):54-9.

Pourhoseingholi A, Vahedi M, Pourhoseingholi MA. Irritable bowel syndrome, gastro-oesophageal reflux disease and dyspepsia: overlap analysis using loglinear models. Arab j gastroenterol. 2012;13(1):20-3.

Funaki Y, Kaneko H, Kawamura Y. Impact of Comorbid Irritable Bowel Syndrome on Treatment Outcome in Non-Erosive Reflux Disease on Long-Term Proton Pump Inhibitor in Japan. Digestion. 2017;96(1):39-45.

Martinucci I, De Bortoli N, Fluri G. P.1.59: diagnosis of nerd in a population of patients with and without IBS: a PH-MII study. Dig liver dis. 2011;43.

Baran M, Cagan Appak Y, Karakoyun M, Yalcinkaya S, Eliacik K, Dundar BN. The overlap of gastroesophageal reflux disease and functional constipation in children: the efficacy of constipation treatment. Eur j gastroenterol hepatol. 2017;29(11):1264-8.

Ford AC, Forman D, Bailey AG, Axon AT, Moayyedi P. The natural history of gastro-oesophageal reflux symptoms in the community and its effects on survival: a longitudinal 10-year follow-up study. Alimentary pharmacol therap. 2013;37(3):323-31.

Lei WY, Chang WC, Wen SH. Impact of concomitant dyspepsia and irritable bowel syndrome on symptom burden in patients with gastroesophageal reflux disease. Journal of the Formosan Medical Association = Taiwan yi zhi. 2019;118(4):797-806.

Wu JC, Lai LH, Chow DK, Wong GL, Sung JJ, Chan FK. Concomitant irritable bowel syndrome is associated with failure of step-down on-demand proton pump inhibitor treatment in patients with gastro-esophageal reflux disease. Neurogastroenterol motility. 2011;23(2):155-60.

El-Salhy M, Gilja OH, Hatlebakk JG. Overlapping of irritable bowel syndrome with erosive esophagitis and the performance of Rome criteria in diagnosing IBS in a clinical setting. Molecular med rep. 2019;20(1):787-94.

Morozova YN, Pogromov AP, Mnatsakanyan MG, Tashchyan OV, Kolosova KY. Esophageal disorders in patients with irritable bowel syndrome. Terapevticheskii arkhiv. 2020;92(2):19-23.

Fujiwara Y, Kubo M, Kohata Y. Cigarette smoking and its association with overlapping gastroesophageal reflux disease, functional dyspepsia, or irritable bowel syndrome. Internal med (Tokyo, Japan). 2011;50(21):2443-7.

Mönnikes H, Schwan T, van Rensburg C. Randomised clinical trial: sustained response to PPI treatment of symptoms resembling functional dyspepsia and irritable bowel syndrome in patients suffering from an overlap with erosive gastro-oesophageal reflux disease. Alimentary pharmacol therap. 2012;35(11):1279-89.

Nam SY, Ryu KH, Park BJ. Irritable bowel syndrome is associated with gastroesophageal reflux symptom but not erosive esophagitis. J neurogastroenterol motility. 2013;19(4):521-31.

Al Saadi T, Idris A, Turk T, Alkhatib M. Epidemiology and risk factors of uninvestigated dyspepsia, irritable bowel syndrome, and gastroesophageal reflux disease among students of Damascus University, Syria. J epidemiol global health. 2016;6(4):285-93.

Mönnikes H, Heading RC, Schmitt H, Doerfler H. Influence of irritable bowel syndrome on treatment outcome in gastroesophageal reflux disease. World j gastroenterol. 2011;17(27):3235-41.

Lovell RM, Ford AC. Prevalence of gastro-esophageal reflux-type symptoms in individuals with irritable bowel syndrome in the community: a meta-analysis. Am j gastroenterol. 2012;107(12):1793-1801.

Drossman DA. The functional gastrointestinal disorders and the Rome III process. Gastroenterology. 2006;130(5):1377-90.

Garros A, Mion F, Marjoux S, Damon H, Roman S. Factors associated with nonresponse to proton pump inhibitors therapy in patients referred for esophageal pH-impedance monitoring. J Int Society Dis Esophagus. 2016;29(7):787-93.

Stanghellini V, Barbara G, Cogliandro R. Overlap between GERD and IBS - Irrefutable but subtle. J Clin Gastroenterol. 2007;41:S114-7.

Jones R, Lydeard S. Irritable bowel syndrome in the general population. BMJ. 1992;304(6819):87-90.

Elsenbruch S. Abdominal pain in Irritable Bowel Syndrome: a review of putative psychological, neural and neuro-immune mechanisms. Brain, behavior, immunity. 2011;25(3):386-94.

Knowles CH, Aziz Q. Visceral hypersensitivity in non-erosive reflux disease. Gut. 2008;57(5):674-83.

Costantini M, Sturniolo GC, Zaninotto G. Altered esophageal pain threshold in irritable bowel syndrome. Dig dis sci. 1993;38(2):206-12.

de Bortoli N, Martinucci I, Bellini M. Overlap of functional heartburn and gastroesophageal reflux disease with irritable bowel syndrome. World j gastroenterol. 2013;19(35):5787-97.

Nastaskin I, Mehdikhani E, Conklin J, Park S, Pimentel M. Studying the overlap between IBS and GERD: a systematic review of the literature. Dig dis sci. 2006;51(12):2113-20.