Epidemiological and Clinical Features of Functional Dyspepsia in a Region with a High Incidence of Esophageal Cancer in China
Functional dyspepsia (FD) is a common gastrointestinal disorder characterized by symptoms such as postprandial fullness, early satiation, epigastric pain, and burning without any identifiable structural abnormalities. Although FD is non-fatal, its chronic and recurrent symptoms significantly impair patients’ quality of life, leading to repeated medical visits and substantial economic burden. The prevalence of FD varies widely across different regions and populations, ranging from 5% to 40% globally. In China, the prevalence of FD varies geographically from 2.4% to 23.5%.
Hua County in Henan Province, China, is an area with a high incidence of esophageal squamous cell carcinoma (ESCC), boasting the highest ESCC mortality rate in the world. This region also has a high prevalence of gastroesophageal reflux disease (GERD). However, the epidemiological characteristics of FD and the validity of the Rome III diagnostic questionnaire for FD in this area have not been extensively studied. This study aimed to investigate the prevalence, epidemiological, and clinical features of FD and organic dyspepsia (OD) in this specific population, as well as to evaluate the relationship between FD and Helicobacter pylori infection.
The study was conducted as part of a general population-based randomized controlled trial (RCT) in Hua County, where gastroscopic screening has been conducted among middle-aged and elderly residents aged 45 to 69 years to assess esophageal cancer. A total of 2916 participants were consecutively recruited from July 2013 to March 2014. Exclusion criteria included a history of malignancy, mental illness, hepatitis B virus, hepatitis C virus, and human immunodeficiency virus infection, and gastroscopy in the past five years. None of the participants had undergone H. pylori screening or eradication treatment.
All participants completed the Gastroesophageal Reflux Disease Questionnaire (GerdQ) and the Chinese version of the Adult Functional Gastrointestinal Disease Rome III Diagnostic Questionnaire. They also underwent gastroscopy. After excluding gastroesophageal reflux disease, uninvestigated dyspepsia (UID) was divided into OD and FD for further analyses. FD was diagnosed if the patient suffered from bothersome postprandial fullness, early satiation, epigastric pain, or epigastric burning in the past three months, and the symptoms had started at least six months before diagnosis. FD was further divided into postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS). PDS was defined as the symptom of postprandial fullness or early satiation occurring several times per week, while EPS was defined as upper abdominal pain happening at least once per week.
The study found that 1705 (58.47%) of the 2916 participants had upper gastrointestinal (GI) symptoms, including heartburn, postprandial fullness, belching, nausea, and reflux. Using the Rome III and GerdQ questionnaires, 166 (5.69%) cases of UID and 310 (10.63%) cases of GERD were preliminarily identified. Gastroscopy revealed 342 (11.73%) cases of organic diseases, including 17 (0.58%) cases of ESCC, two (0.07%) cases of gastric cancer, one (0.03%) case of cardiac cancer, 30 (1.03%) cases of gastric ulcer, 22 (0.75%) cases of duodenal ulcer (DU), and 270 (9.26%) cases of reflux esophagitis (RE).
After combining the questionnaire and gastroscopy results, 149 (5.11%) patients were diagnosed with FD, and 140 (4.80%) were diagnosed with functional esophageal disorders (FED), including 56 (37.58%) patients with PDS, 52 (34.89%) with EPS, and nine (6.04%) with PDS + EPS. Additionally, 32 participants had both FD and FED. Among the patients diagnosed with UID, 10.24% (17/166) were in the OD group, including three patients with ESCC, 13 with RE, and one with DU. The study identified 488 GERD (16.74%) cases, including 270 cases of RE and 218 of non-erosive reflux disease.
Demographic and clinical characteristics of the population showed that patients with ESCC were significantly older than those with FD and FED. The proportion of males was significantly higher in those with GERD and DU than those with functional disorders. Patients with GERD were exposed to more smoke than those with EPS and FED.
Among the UID cases diagnosed solely by questionnaires, OD were further defined by an endoscopic diagnosis. The most common OD detected in the UID group were RE (13/17) and ESCC (3/17). The patients typically presented with postprandial fullness (76.47%), heartburn (52.94%), epigastric pain or burning sensations (47.06%), belching (41.18%), and acid reflux (29.41%). There were no significant differences in the symptoms between the OD and FD groups. The most prominent risk factor for patients in the OD group was a low level of education, while the protective factor was regular vegetable consumption. Compared to the control group, risk factors for patients with OD included the male sex, low level of education, and frequent liquid food consumption.
The most common symptoms of the 149 patients with FD included postprandial fullness (71.14%), epigastric pain or burning sensations (57.05%), belching (37.58%), heartburn (32.89%), and nausea (26.85%). Among these patients, 56 were diagnosed with PDS and 52 with EPS. Common symptoms of PDS included postprandial fullness (89.29%), belching (30.36%), heartburn (26.79%), and early satiation (21.43%). Common symptoms of EPS included epigastric pain or burning (100%), postprandial fullness (42.31%), belching (28.85%), and nausea (25.00%). Patients with PDS + EPS presented with severe upper abdominal symptoms (100% postprandial fullness, 100% epigastric pain or burning sensations, and 55.56% belching). Also, 32 patients presented with significant esophageal-related symptoms and were diagnosed with FED by the Rome III questionnaire and a gastroscopy. Comorbid FED was present in 21.48% of patients with FD; the most common symptoms included postprandial fullness (78.13%), epigastric pain or burning sensations (68.75%), nausea (59.38%), belching (59.38%), heartburn (59.38%), chest pain (53.13%), dysphagia (37.50%), globus hystericus (34.38%), and reflux (31.25%).
Among the 149 FD patients, H. pylori was detected in mucosal biopsies in 34.23% (51/149) of patients, which did not differ from the H. pylori detection rate of the control group (877/2099, 42.26%). When focusing on the symptoms, the proportion of patients with nausea (37.25% vs. 21.43%) and acid reflux (21.57% vs. 8.16%) was significantly higher in FD patients with H. pylori infection than those without. Frequent consumption of spicy foods was a risk factor for PDS, while drinking deep well water tended to be a protective factor for PDS.
In conclusion, the prevalence of FD in the studied population was 5.11%. Gastroscopy should be prescribed for dyspepsia patients to ensure that ESCC and RE are not missed in UID cases diagnosed solely by the Rome III questionnaire. The study highlights the importance of endoscopy in diagnosing and managing dyspepsia, especially in regions with a high incidence of esophageal cancer.
doi.org/10.1097/CM9.0000000000001584
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