Symptom Overlap Stratifies Prokinetic Response in Functional Dyspepsia: A Real-World Multicenter Study of 1297 Chinese Patients.

Objective: Functional dyspepsia (FD) often overlaps with GERD-, IBS-, and FC-like symptoms, complicating treatment. This study evaluated overlap patterns and their association with cinitapride response in Chinese FD patients. Methods: In this multicenter prospective observational study, 1297 Chinese FD patients meeting Rome IV criteria received cinitapride 1 mg three times daily for 4 weeks. Overlapping symptoms were classified as GERD-like, IBS-like, or FC-like. Patients were grouped by overlap complexity: no overlap, one overlapping symptom domain, or two overlapping symptom domains. Symptom improvement was defined as a ≥ 50% reduction in symptom score. Results: Overall, 58.1% of patients had overlapping symptoms: 38.2% had one overlapping domain and 19.9% had two. GERD-like symptoms were the most common isolated overlap and were present in all two-domain overlap cases. IBS-like symptoms, mainly IBS-C-like, predominated among patients with two overlapping domains. Symptom burden increased with overlap complexity, peaking in the GERD-like + IBS-like group. FD-related improvement after cinitapride declined progressively from patients without overlap to those with one and two overlapping domains. After adjustment for demographic and clinical factors, greater overlap complexity remained associated with reduced odds of FD-related response. Conclusion: Symptom overlap is common in Chinese FD patients, especially GERD-like overlap. GERD+IBS overlap was linked to the greatest symptom burden and poorest observed response to cinitapride, suggesting that symptom-defined overlap phenotypes may support more individualized management. Trial Registration: Clinical efficacy and safety of prokinetic agents as maintenance therapy for functional dyspepsia (FD): a real-world study: ChiCTR2100042166. https://www.chictr.org.cn/hvshowproject.html?id=84789&v=1.0.