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Epidemiological studies suggest considerable overlap between functional dyspepsia (FD) and irritable bowel syndrome (IBS).The aim of the present study was to investigate whether coexisting IBS is also associated with symptom pattern or pathophysiology in FD.In 309 consecutive FD patients (207 women, age 42 ± 0.8 yr), questionnaires were used to assess the dyspepsia symptom pattern and the Rome II criteria for IBS. The overall symptom severity was calculated adding the severity score (0–3, 0 = absent, 3 = severe) of eight dyspepsia symptoms. All patients underwent Helicobacter pylori testing, gastric barostat to determine sensitivity to distention and accommodation to a meal, and gastric emptying breath test.Fifty-four percent of the patients had FD alone, whereas 46% had FD + IBS. FD + IBS patients were more likely to be female (75%vs 60%, p < 0.01) and to have a greater weight loss (5.4 ± 0.6 vs 3.5 ± 0.4 kg, p < 0.05). Coexisting IBS did not increase the risk of having any of the dyspeptic symptoms but the overall symptom severity was significantly higher in FD + IBS (12.4 ± 0.4 vs 9.8 ± 0.3, p < 0.01). FD + IBS patients had a lower threshold for first perception (2.9 ± 0.3 vs 3.8 ± 0.3 mmHg, p < 0.05) and for discomfort (7.9 ± 0.4 vs 9.5 ± 0.5 mmHg, p < 0.05) and a greater prevalence of hypersensitivity to gastric distention (44%vs 28%, p < 0.05). Gastric emptying, accommodation to a meal, and prevalence of H. pylori infection did not differ in the two groups.About half of the FD patients fulfill the Rome II criteria for IBS. FD + IBS is more prevalent in female patients and is associated with a higher weight loss, with greater overall symptom severity, and with hypersensitivity to distention.