Overlap of symptoms of dyspepsia and gastroesophageal reflux in the community.

BACKGROUND/AIMS: Dyspepsia and gastroesophageal reflux disease are common chronic diseases. In the clinical setting, some patients express both problems together; however, little is known about the real prevalence of the presence of the two symptoms. Turkey is particularly interesting because of differences observed from developed countries. We aimed to derive data from our previous prevalence of gastroesophageal reflux disease study and evaluate the overlap of the two symptoms. METHODS: We used a previously validated and culturally adapted reflux questionnaire, which was translated into Turkish. The questionnaire was applied to 630 randomly selected subjects older than 20 years living in a population of 8857 adults. RESULTS: 28.6% (180/630) of all responders defined dyspepsia within the last 12-month period. When symptom prevalence was considered at least weekly, the prevalence was 10% for heartburn, 15.6% for acid regurgitation, and 20% for either symptom. While the prevalence of gastroesophageal reflux disease was 29.4% in patients with dyspepsia, dyspepsia was found in 43.1% of patients with gastroesophageal reflux disease. Only 21% of symptomatic subjects or 8.4% of the entire study population had both symptoms. Dyspepsia was defined as the most bothersome symptom. 54.3% of all dyspeptic patients and 67.3% with both gastroesophageal reflux disease and dyspepsia used a gastric medication (p>0.05). 29.9% of subjects with dyspeptic symptoms defined antacid consumption and 28.3% acid inhibitor therapy. CONCLUSION: Dyspepsia was defined as the most bothersome symptom compared to gastroesophageal reflux disease symptoms. The prevalence of dyspepsia in patients with gastroesophageal reflux disease is more common than vice versa. However, the overlap of the two symptom groups was lower than expected in this low-income, Caucasian population.

Gastroesophageal reflux disease in a low-income region in Turkey.

OBJECTIVES: Detailed population-based data regarding the prevalence and symptom profile of gastroesophageal reflux disease (GERD) in underdeveloped and developing Caucasian countries are lacking. The aim of this study was to determine the prevalence and clinical spectrum of GERD in a low-income region in Turkey. METHODS: We used a previously validated reflux questionnaire, which was translated into Turkish and culturally adapted. The questionnaire was applied to 630 randomly selected participants greater than 20 yr old living in a population of 8,857 adults, with a low mean income of 75 dollars/person/month. The reliability and reproducibility of the questionnaire were calculated using the kappa statistic (test-retest). Endoscopy and/or 24-h intraesophageal pH monitoring were used to ascertain its validity in identifying patients with reflux. RESULTS: The prevalence of GERD symptoms was 10% for heartburn, 15.6% for regurgitation, and 20% for either symptom experienced at least weekly (95% CI). Heartburn and regurgitation were associated with noncardiac chest pain (37.3%), dysphagia (35.7%), dyspepsia (42.1%), odynophagia (35.7%), globus, hoarseness, cough, hiccup, nausea, vomiting, belching, and NSAID use, but not with body mass index in both frequent and occasional symptom groups. The prevalence of heartburn symptoms, but not regurgitation, increased significantly with age. CONCLUSIONS: The prevalence of GERD in a low-income population in Turkey was similar to that of developed countries, although with a different symptom profile, namely, a lower incidence of heartburn and a higher incidence of regurgitation and dyspepsia. These findings support the contention that there are a large number of patients worldwide in underdeveloped nations with poorly recognized and largely undertreated GERD.

Chloride transport in rabbit esophageal epithelial cells.

We investigated Cl(-) transport pathways in the apical and basolateral membranes of rabbit esophageal epithelial cells (EEC) using conventional and ion-selective microelectrodes. Intact sections of esophageal epithelium were mounted serosal or luminal side up in a modified Ussing chamber, where transepithelial potential difference and transepithelial resistance could be determined. Microelectrodes were used to measure intracellular Cl(-) activity (a), basolateral or apical membrane potentials (V(mBL) or V(mC)), and the voltage divider ratio. When a basal cell was impaled, V(mBL) was -73 +/- 4.3 mV and a(i)(Cl) was 16.4 +/- 2.1 mM, which were similar in presence or absence of bicarbonate. Removal of serosal Cl(-) caused a transient depolarization of V(mBL) and a decrease in a(i)(Cl) of 6.5 +/- 0.9 mM. The depolarization and the rate of decrease of a(i)(Cl) were inhibited by approximately 60% in the presence of the Cl(-)-channel blocker flufenamate. Serosal bumetanide significantly decreased the rate of change of a(i)(Cl) on removal and readdition of serosal Cl(-). When a luminal cell was impaled, V(mC) was -65 +/- 3.6 mV and a was 16.3 +/- 2.2 mM. Removal of luminal Cl(-) depolarized V(mC) and decreased a by only 2.5 +/- 0.9 mM. Subsequent removal of Cl(-) from the serosal bath decreased a(i)(Cl) in the luminal cell by an additional 6.4 +/- 1.0 mM. A plot of V(mBL) measurements vs. log a(i)(Cl)/log a(o)(Cl) (a(o)(Cl) is the activity of Cl(-) in a luminal or serosal bath) yielded a straight line [slope (S) = 67.8 mV/decade of change in a(i)(Cl)/a(o)(Cl)]. In contrast, V(mC) correlated very poorly with log a/a (S = 18.9 mV/decade of change in a/a). These results indicate that 1) in rabbit EEC, a(i)(Cl) is higher than equilibrium across apical and basolateral membranes, and this process is independent of bicarbonate; 2) the basolateral cell membrane possesses a conductive Cl(-) pathway sensitive to flufenamate; and 3) the apical membrane has limited permeability to Cl(-), which is consistent with the limited capacity for transepithelial Cl(-) transport. Transport of Cl(-) at the basolateral membrane is likely the dominant pathway for regulation of intracellular Cl(-).