Epidemiological and Clinical Features of Functional Dyspepsia in a Region With a High Incidence of Esophageal Cancer in China

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Epidemiological and Clinical Features of Functional Dyspepsia in a Region With a High Incidence of Esophageal Cancer in China

Imagine living in a place where esophageal squamous cell carcinoma (ESCC)—a type of throat cancer—is among the most common cancers worldwide. Now, imagine dealing with persistent stomach pain, bloating, or early fullness after meals—symptoms of functional dyspepsia (FD). Would you know if those symptoms are harmless or a sign of something more serious?

For residents of Hua County, Henan Province, China—an area with one of the highest ESCC mortality rates globally—this question is personal. Until recently, FD (a chronic digestive condition with no clear physical cause) had rarely been studied here. A 2021 study by researchers from Peking University Third Hospital and Peking University Cancer Hospital set out to change that, exploring how FD and “organic dyspepsia” (OD)—dyspepsia caused by physical issues like reflux or cancer—present in this high-risk population. Here’s what they found, and why it matters for anyone with digestive symptoms in similar regions.

What Is Functional Dyspepsia?

FD is a common digestive disorder marked by bothersome symptoms like:

  • Postprandial fullness (feeling overly bloated after eating)
  • Early satiation (feeling full after a few bites)
  • Epigastric pain or burning (pain in the upper stomach)
  • Nausea or belching

Unlike OD, FD isn’t caused by structural problems (e.g., ulcers, cancer) or infections. It’s “functional,” meaning the issue lies in how the gut works—not what it looks like. While FD isn’t life-threatening, its chronic, recurrent symptoms can wreck quality of life and lead to repeated doctor visits.

Why Hua County Matters

Hua County is a hot spot for ESCC, with rates far higher than the global average. It also has a high prevalence of gastroesophageal reflux disease (GERD), a condition where stomach acid flows back into the esophagus. But until this study, no one knew how FD overlapped with these risks—or if FD symptoms could mask more serious conditions like ESCC.

The researchers focused on middle-aged and elderly residents (45–69 years old) because ESCC and FD both affect older adults. They recruited 2,916 participants from a larger esophageal cancer screening trial, all of whom completed symptom questionnaires and underwent gastroscopy (a test that uses a camera to look inside the esophagus and stomach).

Key Findings From the Study

The team’s goal was to answer two big questions: How common is FD in Hua County? and Can FD symptoms hide serious organic diseases like ESCC? Here’s what they discovered:

1. Most “Uninvestigated Dyspepsia” Cases Are Harmless—But 10% Are Not

First, the researchers used the Rome III questionnaire (a standard tool for diagnosing functional gut disorders) to identify “uninvestigated dyspepsia” (UID)—dyspepsia symptoms without a gastroscopy. They found 166 UID cases (5.69% of participants).

But when they did gastroscopies, 10.24% of those UID cases turned out to be organic dyspepsia (OD)—meaning the symptoms were caused by a physical problem. The most common OD issues were:

  • Reflux esophagitis (RE): Stomach acid damaging the esophagus (13 cases)
  • ESCC: Throat cancer (3 cases)
  • Duodenal ulcer: A sore in the first part of the small intestine (1 case)

This is a critical finding: You can’t tell FD and OD apart just from symptoms. Both groups reported similar issues (e.g., bloating, heartburn). The only way to rule out serious conditions like ESCC or RE is with a gastroscopy.

2. FD Prevalence in Hua County Is 5.11%—With PDS as the Most Common Subtype

After excluding OD cases, the team found 149 FD patients (5.11% of the total population). FD is split into two main subtypes:

  • Postprandial distress syndrome (PDS): Symptoms like bloating or early fullness after meals (37.6% of FD cases)
  • Epigastric pain syndrome (EPS): Constant or recurrent upper stomach pain (34.9% of FD cases)
  • Mixed PDS + EPS: Both sets of symptoms (6% of FD cases)
  • FD + functional esophageal disorders (FED): FD plus esophageal symptoms like heartburn or chest pain (21.5% of FD cases)

PDS was the most common subtype—no surprise, since post-meal bloating is a top complaint for many FD patients.

3. Risk Factors for FD and OD

The study also uncovered lifestyle factors linked to FD and OD:

  • OD risk factors: Being male, having a low education level, and eating liquid foods frequently.
  • OD protective factor: Eating fresh vegetables regularly (which aligns with other studies showing veggies lower ESCC risk).
  • FD risk factor for PDS: Frequent spicy food consumption (odds ratio: 2.09, meaning spicy food eaters were twice as likely to have PDS).
  • FD protective factor for PDS: Drinking deep well water (odds ratio: 0.43, meaning deep well water drinkers were 57% less likely to have PDS).

4. Helicobacter pylori Isn’t a Major Driver of FD Here

While H. pylori (a stomach bacteria) is linked to ulcers and FD in some populations, the infection rate in FD patients (34.23%) was similar to the control group (42.26%). However, H. pylori-positive FD patients had worse nausea and acid reflux—so treating the infection might still help some symptoms.

What This Means for Patients and Doctors

The study’s biggest takeaway is simple: If you live in a high ESCC area and have dyspepsia symptoms, get a gastroscopy. Ten percent of UID cases in Hua County were OD—including ESCC, a cancer that’s highly treatable if caught early.

For FD patients, the findings offer practical advice:

  • If you have PDS (post-meal bloating), cutting back on spicy food might help.
  • Drinking deep well water (instead of surface water) could lower your risk of PDS.
  • If you have FD plus esophageal symptoms (e.g., heartburn, chest pain), ask your doctor about testing for FED—these conditions often overlap.

Why This Study Is a Game-Changer

Most FD research focuses on low-risk populations, not areas where ESCC is rampant. This study fills a critical gap, showing that:

  • FD is less common in Hua County (5.11%) than in some other Asian regions—likely because the elderly population here has a slower lifestyle and fewer stressors.
  • The Rome III questionnaire alone isn’t enough to diagnose FD in high-risk areas—gastroscopy is non-negotiable.
  • Symptoms like heartburn or belching aren’t just “FD quirks”—they could signal overlapping conditions like GERD or FED.

Final Thoughts

For residents of Hua County—and anyone living in a high ESCC area—this study is a wake-up call. Digestive symptoms shouldn’t be ignored, and “wait-and-see” isn’t a safe approach. Gastroscopy isn’t just a test—it’s a lifesaver.

For researchers, the study highlights the need for more region-specific FD research. What works for FD patients in New York or Tokyo might not work for someone in rural Henan.

And for everyone else? It’s a reminder that digestive health is personal—and sometimes, the only way to get answers is to look inside.

This study was published in the Chinese Medical Journal (2021;134:1422–1430) by Nan Hu, Kun Wang, Li Zhang, Zuo-Jing Liu, Zhu Jin, Rong-Li Cui, He-Jun Zhang, Zhong-Hu He, Yang Ke, and Li-Ping Duan from the Department of Gastroenterology at Peking University Third Hospital and Peking University Cancer Hospital and Institute.

doi: 10.1097/CM9.0000000000001584

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