Introduction

Irritable bowel syndrome (IBS) and functional dyspepsia (FD) are common disorders of gut-brain interaction (DGBI), and bloating and visible abdominal distension are common symptoms among individuals with IBS and/or FD. Bloating refers to a subjective sensation of tension or pressure in the abdomen, which may or may not be reported together with visible abdominal distension. The underlying pathophysiological mechanisms may differ, with bloating suggested to be more related to hypersensitivity and visible abdominal distension to altered motility. The prevalence of these two symptoms in IBS and FD, especially as distinct symptoms, is not well known.

Aims & Methods

The aim was to investigate the link between bloating and distension with IBS and FD. Therefore, we performed a population-based internet survey of adults in the US, UK, and Mexico, including Rome IV IBS and FD diagnostic questions, somatization (PHQ-12), and psychological distress (PHQ-4). Four groups were created: those meeting the Rome IV criteria for IBS only, FD only, both IBS+FD, and a reference group including individuals without IBS, FD and organic diagnoses that could result in IBS- or FD-like symptoms. Within each group, we identified individuals who reported ≥weekly bloating alone (B), ≥weekly visible abdominal distension alone (D), ≥weekly combined B+D, or neither of both. The relationship between B, D and B+D in those with IBS and/or FD vs. the reference group was investigated using logistic regression models.

Results

The analysis included 5,448 participants (49.7% female; mean age 46.5 years, range 18-99), with 131 meeting criteria for IBS only, 360 for FD only, 217 for IBS+FD and 4,740 for the reference group. A larger proportion of individuals with IBS only (64.9%), FD only (50.6%), and especially those with IBS+FD (88.5%) reported bloating and/or visible abdominal distension compared to the reference group (13.7%). In the IBS only group, 16.0% reported bloating alone, 8.4% visible abdominal distension alone, and 40.5% combined bloating and visible abdominal distension. In the FD only group this was 12.8% (B), 8.9% (D), and 28.9% (B+D), and in the IBS+FD group 18.9% (B), 8.3% (D), and 61.3% (B+D), respectively. Reporting bloating alone or combined bloating and visible abdominal distension was strongly linked to fulfilling criteria for IBS only, FD only, and concomitant IBS+FD vs. the reference group, with weaker links for visible abdominal distension in the absence of bloating (Table). After adjusting for age, sex, BMI, psychological distress and somatization, the links persisted. The strongest association was observed between combined bloating and visible abdominal distension (vs. neither) and concomitant IBS+FD (vs. the reference group); adjusted odds ratio 28.6 [95%CI 17.6-46.6].

Conclusion

Bloating and visible abdominal distension as distinct and overlapping symptoms are strongly linked to IBS, FD, and concomitant IBS+FD in the general population. Assessing bloating and visible abdominal distension as separate symptoms may be important to enable individualized treatment for individuals with IBS and FD.

Introduction

Gastroesophageal reflux disease (GERD) is a common disorder characterized by the backward flow of stomach contents into the esophagus, impacting millions globally and significantly reducing quality of life. Typical symptoms include heartburn and acid reflux, while atypical presentations may involve noncardiac chest pain, chronic cough, and laryngitis(1).Over the past decade (2010–2021), GERD incidence and prevalence have risen sharply in Europe compared to global trends, leading to increased disability-adjusted life years (DALYs). Its multifactorial pathogenesis—driven by chemical, mechanical, psychological, and neurological mechanisms—affects symptom severity, diagnosis, and therapeutic outcomes(2).

Aims & Methods

This study aims to investigate the escalating burden of Gastroesophageal Reflux Disease (GERD) in Europe from 2010 to 2021, comparing its incidence, prevalence, and disability-adjusted life years (DALYs) with global trends to evaluate current healthcare policies and highlight the need for streamlined, evidence-based interventions that address regional disparities in disease burden. The findings will support policy refinement, ensuring healthcare systems are equipped with effective prevention strategies, optimized treatment protocols, and equitable resource allocation to reduce GERD’s long-term impact on patient health and healthcare infrastructure.
Incidence, Prevalence and disability-adjusted life years (DALYs) were calculated using the Global Burden of Disease (GBD) Database 2021. Joinpoint regression was used to calculate annual percentage changes (APCs) in ASDR, DALYs, and YLL with 95% uncertainty intervals, and significant trends over time were identified. Statistical significance was set at a p-value of <0.05

Results

Globally, GERD-related DALYs increased from 72.24 per 100,000 (95% CI: 36.45–128.77) in 2010 to 75.56 per 100,000 (95% CI: 38.05–133.87) in 2021. Prevalence rose from 9,398.70 per 100,000 (95% CI: 8,342.02–10,517.59) in 2010 to 9,838.60 per 100,000 (95% CI: 8,732.46–11,056.05) in 2021, while incidence climbed from 3,717.75 per 100,000 (95% CI: 3,298.17–4,113.24) in 2010 to 3,881.86 per 100,000 (95% CI: 3,445.56–4,299.95) in 2021.
Europe saw GERD-related DALYs rise from 75.38 per 100,000 (95% CI: 37.98–133.77) in 2010 to 77.57 per 100,000 (95% CI: 39.13–137.23) in 2021. Prevalence increased to 10,091.72 per 100,000 (95% CI: 8,938.24–11,206.79), and incidence reached 3,978.62 per 100,000 (95% CI: 3,521.81–4,418.93) in 2021.
Eastern Europe consistently showed the highest GERD burden, followed by Central Europe, while Western Europe had the lowest figures.

• Eastern Europe: 88.73 DALYs per 100,000 (95% CI: 44.67–156.85) in 2021
• Central Europe: 86.05 per 100,000 (95% CI: 43.45–152.64)
• Western Europe: 63.30 per 100,000 (95% CI: 31.76–112.67)

Conclusion

The increasing burden of Gastroesophageal Reflux Disease (GERD) in Europe from 2010 to 2021, particularly in Eastern Europe, highlights the need for targeted healthcare interventions. With rising incidence, prevalence, and disability-adjusted life years (DALYs), addressing lifestyle, environmental, and healthcare access disparities is essential. Streamlined policies, optimized treatment strategies, and preventive measures can help mitigate GERD’s impact, improve patient outcomes, and reduce the strain on healthcare systems.

References

1-Mahajan R, Kulkarni R, Stoopler ET. Gastroesophageal reflux disease and oral health: A narrative review. Spec Care Dentist. 2022;42(6):555-564. doi:10.1111/scd.12726
2-Sharma P, Yadlapati R. Pathophysiology and treatment options for gastroesophageal reflux disease: looking beyond acid. Ann N Y Acad Sci. 2021;1486(1):3-14. doi:10.1111/nyas.14501

Disclosure

No conflict of interest.