Outpatient visit frequency in patients with overlapping non-erosive reflux disease and epigastric pain syndrome: A multicenter study

doi:10.3748/wjg.119326

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastroenterol. Jul 28, 2026; 32(28): 119326
Published online Jul 28, 2026. doi: 10.3748/wjg.119326

Outpatient visit frequency in patients with overlapping non-erosive reflux disease and epigastric pain syndrome: A multicenter study

Mi Lv, Xin Liu, Kai-Yue Huang, Lu-Si Xu, Hui Che, Meng-Xi Yao, Feng-Yun Wang

Mi Lv, Kai-Yue Huang, Lu-Si Xu, Department of Gastroenterology (Spleen and Stomach Diseases), Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing 100091, China

Xin Liu, Graduate School, Beijing University of Chinese Medicine, Beijing 100029, China

Hui Che, Feng-Yun Wang, Institute of Digestive Diseases, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing 100091, China

Meng-Xi Yao, Department of Gastroenterology (Spleen and Stomach Diseases), Changping Hospital of Traditional Chinese Medicine, Beijing 102200, China

Author contributions: Lv M conceived and designed the study, supervised the project, acquired and curated data, performed formal analysis and investigation, developed the methodology and software, administered the project, acquired resources, validated results, created visualizations, and wrote the original draft; Liu X and Huang KY contributed equally to conceptualization and data curation; Liu X led the methodology and validation; Huang KY additionally contributed to methodology, software, and validation; Xu LS contributed equally to data curation, formal analysis, methodology, and software; Che H led the methodology and supervision, and contributed equally to reviewing and editing the manuscript; Yao MX contributed equally to conceptualization and data curation; Wang FY led data curation, funding acquisition, methodology, resources, supervision, and the review and editing of the manuscript. All authors participated in critically revising the manuscript for important intellectual content and have read and approved the final submitted version.

AI contribution statement: No artificial intelligence tools (such as ChatGPT, Grammarly, DeepL, or similar) were used in drafting or revising this manuscript. No part of the main text (Abstract, Introduction, Materials and Methods, Results, Discussion, or Conclusion) was generated by AI, either wholly or partially. No AI tool was used for language polishing, translation, data analysis, or writing assistance. No AI tool participated in the study design, data processing, interpretation of results, or any other research activity. All figures, tables, and images in the manuscript were independently created by the authors, and none were generated by AI. We confirm that this manuscript is the original work of our research team.

Supported by the National Natural Science Foundation of China, No. 82374434 and No. 82174363; the Youth Science Foundation Project of the National Natural Science Foundation of China, No. 82205104; and the Excellent Young Scientific and Technological Talent Training Program of the Fundamental Scientific Research Business Expenses of China Academy of Chinese Medical Sciences, No. ZZ16-YQ-002.

Institutional review board statement: The study protocol was approved by the Ethics Committees of all participating centers (Approval No. 2022XLA041-1 and No. 2022-039).

Informed consent statement: Informed consent was obtained from all individual participants included in this study.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: With the consent of the corresponding author, we will be able to provide the raw data.

Corresponding author: Feng-Yun Wang, MD, Chief Physician, Professor, Institute of Digestive Diseases, Xiyuan Hospital of China Academy of Chinese Medical Sciences, No. 1 Xiyuan Playground, Haidian District, Beijing 100091, China. 18810631761@163.com

Received: January 26, 2026
Revised: February 26, 2026
Accepted: April 1, 2026
Published online: July 28, 2026
Processing time: 168 Days and 14.9 Hours

Abstract

BACKGROUND

The overlap between non-erosive reflux disease (NERD) and epigastric pain syndrome (EPS) is common in China, but its clinical profile and healthcare burden are poorly defined.

AIM

To characterize patients with NERD-EPS overlap and identify factors linked to frequent gastroenterology clinic visits.

METHODS

In a multicenter, cross-sectional study, 800 consecutive patients with NERD-EPS overlap were enrolled from four tertiary hospitals in China. Data were collected via questionnaires on socio-demographics, clinical manifestations, medication use, visit frequency, and psychological distress (4-item Patient Health Questionnaire). Multivariable ordinal logistic regression identified factors independently associated with higher visit frequency.

RESULTS

Among the 800 patients (mean age 44.50 ± 14.43 years; 66.70% female), 42.40% had ≥ 3 clinic visits. Independent risk factors for more frequent visits included older age [adjusted odds ratio (aOR) = 1.02], longer NERD duration (aOR = 1.004), higher psychological distress (aOR = 1.08 per 1-point 4-item Patient Health Questionnaire increase), mixed labor (aOR = 3.37) or physical labor (aOR = 1.91), married status (aOR = 2.05), proton pump inhibitor use (aOR = 1.39), and Chinese herbal preparation use (aOR = 6.64). A significant synergistic interaction on visit frequency was found between proton pump inhibitor and herbal use (interaction aOR = 29.06, P < 0.001).

CONCLUSION

Frequent outpatient visits in NERD-EPS overlap is driven by a combination of demographic factors, chronicity, psychological comorbidity, and complex medication patterns, rather than symptoms alone. These findings highlight the strong association between psychological distress and frequent visits, suggesting that integrating psychological screening into routine care may help identify at-risk patients. Prospective studies are needed to determine whether psychosomatic interventions can effectively reduce healthcare utilization in this population.

Keywords: Non-erosive reflux disease; Epigastric pain syndrome; Biopsychosocial model; Outpatient visits frequency; Cross-sectional study

Core Tip: In this first large-scale multicenter study of overlapping non-erosive reflux disease and epigastric pain syndrome in China, frequent healthcare visits were driven not by symptom severity, but by a profile combining chronicity, psychological distress, and complex medication patterns. A striking interaction between proton pump inhibitor and Chinese herbal medicine use identified a high-need subgroup. These findings highlight the importance of an integrated, psychosomatic approach addressing both peripheral and central mechanisms to reduce the healthcare burden in this population.