• Moritz von Wulffen, Nicholas J Talley, Johann Hammer, Jessica McMaster, Graeme Rich, Ayesha Shah, Natasha Koloski, Bradley J Kendall, Mike Jones, and Gerald Holtmann.
• Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, 199 Ipswich Rd, Woolloongabba, Brisbane, QLD, 4102, Australia.
• Dig. Dis. Sci. 2019 Feb 1; 64 (2): 480-486.

BackgroundAccording to Rome IV criteria, functional dyspepsia (FD) and irritable bowel syndrome (IBS) are distinct functional gastrointestinal disorders (FGID); however, overlap of these conditions is common in population-based studies, but clinical data are lacking.AimsTo determine the overlap of FD and IBS in the clinical setting and define risk factors for the overlap of FD/IBS.MethodsA total of 1127 consecutive gastroenterology outpatients of a tertiary center were recruited and symptoms assessed with a standardized validated questionnaire. Patients without evidence for structural or biochemical abnormalities as a cause of symptoms were then categorized based upon the symptom pattern as having FD, IBS or FD/IBS overlap. Additionally, this categorization was compared with the clinical diagnosis documented in the integrated electronic medical records system.ResultsA total of 120 patients had a clinical diagnosis of a FGID. Based upon standardized assessment with a questionnaire, 64% of patients had FD/IBS overlap as compared to 23% based upon the routine clinical documentation. In patients with severe IBS or FD symptoms (defined as symptoms affecting quality of life), the likelihood of FD/IBS overlap was substantially increased (OR = 3.1; 95%CI 1.9-5.0) and (OR = 9.0; 95%CI 3.5-22.7), respectively. Thus, symptom severity for IBS- or FD symptoms were significantly higher for patients with FD/IBS overlap as compared to patients with FD or IBS alone (p all < 0.01). Age, gender and IBS-subtype were not associated with overlap.ConclusionIn the clinical setting, overlap of FD and IBS is the norm rather than the exception. FD/IBS overlap is associated with a more severe manifestation of a FGID.

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