ArticleLiterature Review

Psychological and emotional aspect of gastroesophageal reflux disease

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Abstract

A synergy exists between the psychological and physiological aspects of esophageal and other gastrointestinal symptoms. Based on a biopsychosocial model of disease, several multidisciplinary concepts of interventions in gastrointestinal disorders have been evaluated. The role of psychological factors in gastroesophageal reflux disease (GERD) has been under study. This article reviews psychological and emotional factors influencing GERD symptoms and treatment.

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... Few population-based studies have investigated the association between GORD-related symptoms and psychopathology [16]. Those that have, report increased odds of reflux in people suffering anxiety and depression, although most utilising self-report symptom scales [1,17,18] and one study using data from medical records [10]. ...
... There are many possible explanations for the association between psychopathology and GORD-related symptoms. As suggested by Kamolz and Velonovich [16], the relationship may be attributed to changes in oesophageal motility and LOS function in response to stressors. In addition, visceral hypersensitivity, which would also explain the frequent overlap between heartburn and irritable bowel syndrome [27] may be caused by psychological factors influencing stimuli processing in the central nervous system (CNS) [28]. ...
... Although little is known about the morphological organization of serotonergic neurons in the Table 2 Age-adjusted (model I) and age-and BMI-adjusted (model II) odds ratios for GORD in women with mood and anxiety disorders and symptomatology oesophagus, laboratory and clinical investigations have indicated that serotonin, the main target of both depression and anxiety treatment, plays a role in oesophageal motility [29,30], leading to neurohormonal interaction between the CNS and the gastrointestinal system. On the other hand, it is plausible that the presence of GORD-related symptoms can evoke feelings of depression or anxiety [16] or that there are a subset of patients with co-occurring vulnerability to both mood/anxiety and reflux symptoms [3]. Lastly, there is no evidence, endoscopic or otherwise, that identifies which factors of reflux are significantly related to mental illness [2]. ...
Article
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Psychopathology seems to play a role in reflux pathogenesis and vice versa, yet few population-based studies have systematically investigated the association between gastro-oesophageal reflux disease (GORD) and psychopathology. We thus aimed to investigate the relationship between GORD-related symptoms and psychological symptomatology, as well as clinically diagnosed mood and anxiety disorders in a randomly selected, population-based sample of adult women. This study examined data collected from 1084 women aged 20-93yr participating in the Geelong Osteoporosis Study. Mood and anxiety disorders were identified using the Structured Clinical Interview for DSM-IV-TR Research Version, Non-patient edition, and psychological symptomatology was assessed using the General Health Questionnaire (GHQ-12). GORD-related symptoms were self-reported and confirmed by medication use where possible and lifestyle factors were documented. Current psychological symptomatology and mood disorder were associated with increased odds of concurrent GORD-related symptoms (adjusted OR 2.1, 95%CI 1.3-3.5, and OR 3.03, 95%CI 1.7-5.6, respectively). Current anxiety disorder also tended to be associated with increased odds of current GORD-related symptoms (p=0.1). Lifetime mood disorder was associated with a 1.6-fold increased odds of lifetime GORD-related symptoms (adjusted OR 1.6, 95%CI 1.1-2.4) and lifetime anxiety disorder was associated with a 4-fold increased odds of lifetime GORD-related symptoms in obese but not non-obese participants (obese, age-adjusted OR 4.0 95%CI 1.8-9.0). These results indicate that psychological symptomatology, mood and anxiety disorders are positively associated with GORD-related symptoms. Recognising this common comorbidity may facilitate recognition and treatment, and opens new questions as to the pathways and mechanisms of the association.
... In addition, it has been reported that GERD symptoms may result in anxiety and depression. 14,17 In other words, there is a possibility that GERD symptoms may affect PB through psychological instability due to the anxiety or depression. ...
... Considering the aforementioned associations of PB with sleep problems and sleep bruxism, 3-8 the association between GERD symptoms and sleep problems, 10,11 and the association between PB and GERD symptoms, 14,17 these relationships are assumed to have associations with adolescents' psychological wellbeing. Additionally, recent studies have reported an association between sleep bruxism and gastroesophageal reflux in adults. ...
... Several studies have suggested that GERD symptoms are associated with psychological problems, reporting that these symptoms may result in anxiety and/or depression due to the discomfort caused by reflux. 14,17 Those studies indicated that psychiatric disorders such as anxiety or depression can influence an individual's perception of reflux symptoms, thus potentially leading to discomfort the following day. GERD events during sleep have been reported to increase micro-arousals. ...
Article
There are few large-scale epidemiologic studies examining the associations between sleep problems, gastroesophageal reflux disease (GERD) symptoms, lifestyle and food habits and problem behaviors in adolescents. The objective of this study was to evaluate the associations among these factors in Japanese adolescents. We performed a cross-sectional survey of 1,840 junior high school students using questionnaires. The subjects were classified into problem behavior (PB) or normal behavior (NB) groups by using the Pediatric Symptom Checklist. The scores of the sleep-related factors, sleep bruxism, lifestyle and food habits, and GERD symptoms were compared. Logistic regression analysis was performed to determine the factors related to problem behaviors. The mean age was 13.3 ± 1.8 years. The PB group had significantly longer sleep latency and higher scores of GERD symptoms (P < 0.001). Furthermore, the PB group was significantly more likely to experience absences of the mother at dinner time, skip breakfast, and have less than 30 min of conversation among family at dinner time. The PB group had significantly higher frequencies of sleep bruxism, difficulty falling asleep within 30 min, nightmares, feeling of low sleep quality, daytime somnolence, and daytime lack of motivation. Feelings of low sleep quality had the strongest association with problem behaviors, with an adjusted OR (95% CI) of 12.88 (8.99-18.46). Our large-scale cross-sectional study found that problem behaviors in adolescents were associated with sleep problems, including sleep bruxism, as well as lifestyle and food habits and GERD symptoms.
... These factors may affect how patients perceive their symptoms. Several studies have demonstrated a correlation between the presence of psychological factors or some psychiatric disease and GERD [14,15]. A Taiwanese study also revealed the adverse effect of GERD on sleep, even in the absence of reflux symptoms [16]. ...
... A Taiwanese study also revealed the adverse effect of GERD on sleep, even in the absence of reflux symptoms [16]. Although GERD may lead to psychological comorbidities and unexplained sleep disturbance, their inter-relationship remains unclear [14][15][16]. ...
... In particular, a strong positive association was observed between depression and SEE even after adjustment by multivariate analysis. Previous studies have shown that individuals with anxiety or depression are at an increased risk for developing reflux symptoms [14,36]. A Korean report also revealed that the severity of anxiety and depression was higher in subjects with GERD as compared to healthy adults [37]. ...
Article
Background Asymptomatic erosive esophagitis by definition is a condition lacking any reflux symptom. Aims We aimed to investigate the prevalence of asymptomatic erosive esophagitis in a general population undergoing periodic health checkup. Methods Consecutive subjects undergoing a medical checkup were enrolled for evaluation of reflux disease with upper endoscopy and a validated reflux questionnaire. The presence and severity of erosive esophagitis were evaluated. In all subjects, demographic characteristics and biochemical data were recorded, and sleep and psychological characteristics were assessed by means of self-administered Pittsburgh Sleep Quality Index score, Taiwanese Depression Questionnaire score, and State-Trait Anxiety Inventory score. Results Of 2568 subjects eligible for this study, erosive esophagitis was found in 676 subjects (26.3%), in whom the proportions of asymptomatic and symptomatic erosive esophagitis were 59.2% (400 subjects) and 40.8% (276 subjects) respectively. At a univariate analysis, it was found that asymptomatic erosive esophagitis subjects were more frequently of female gender, of older age, with a lower level of education. They also showed less alcohol and tea consumption, less depression, less anxiety, lower serum level of triglyceride, and lower prevalence of metabolic syndrome. Multivariate analysis revealed that female sex (OR = 1.645, p = 0.0146) was a positive predictive factor for asymptomatic erosive esophagitis, whereas higher level of education (OR = 0.564, p = 0.044), higher Taiwanese Depression Questionnaire score (OR = 0.922, p < 0.001), and the presence of metabolic syndrome (OR = 0.625, p = 0.0379) were negative predictive factors. Conclusions Asymptomatic erosive esophagitis is a common feature in otherwise healthy subjects and is independently associated with female gender, lower education level, less depression, and lower prevalence of metabolic syndrome.
... Comorbid psychiatric disorders, such as anxiety and depression, are prevalent in patients with GERD, as well as GERD-related chest pain [13] . Approximately 60% of GERD patients reported worsening of the symptoms during stress [14] . Additionally, there were no significant correlations between the severity of GERD symptoms and the pathophysiological abnormalities detected by 24-h pH monitoring and esophageal manometry, further suggesting the influence of psychiatric factors in symptom perception [14] . ...
... Approximately 60% of GERD patients reported worsening of the symptoms during stress [14] . Additionally, there were no significant correlations between the severity of GERD symptoms and the pathophysiological abnormalities detected by 24-h pH monitoring and esophageal manometry, further suggesting the influence of psychiatric factors in symptom perception [14] . It has already been documented that stress and psychological comorbidities may predispose individuals to be more vigilant for physiological sensations, which may result in enhanced response to a painful stimulus or a painful response to an innocuous stimulus and, in some instances, trigger or worsen chest pain of cardiac or esophageal origin [5,11,15] . ...
... The effect of psychosocial factors on the pathogenesis of NCCP is also widely accepted [5,9,13] . These psychological and emotional factors may affect how patients perceive their symptoms [14] . This may partially explain why even slight physiologic stimuli can be interpreted as major symptoms by patients and significantly affect QoL, resulting in dissatisfaction with conventional treatment [14,30] . ...
Article
Aim: To investigate the effects of depression and anxiety on health-related quality of life (QoL) in gastroesophageal reflux disease (GERD) patients and those suffering from cardiac (CCP) and noncardiac (NCCP) chest pain in Wuhan, China. Methods: In this cross-sectional study, a total of 358 consecutive patients with GERD were enrolled in Wuhan, China, of which 176 subjects had complaints of chest pain. Those with chest pain underwent coronary angiography and were divided into a CCP group (52 cases) and NCCP group (124 cases). Validated GERD questionnaires were completed, and the 36-item Short-Form Health Survey and Hospital Anxiety/Depression Scale were used for evaluation of QoL and psychological symptoms, respectively. Results: There were similar ratios and levels of depression and anxiety in GERD with NCCP and CCP. However, the QoL was obviously lower in GERD with CCP than NCCP (48.34 ± 17.68 vs 60.21 ± 20.27, P < 0.01). In the GERD-NCCP group, rather than the GERD-CCP group, the physical and mental QoL were much poorer in subjects with depression and/or anxiety than those without anxiety or depression. Anxiety and depression had strong negative correlations with both physical and mental health in GERD-NCCP (all P < 0.01), but only a weak relationship with mental components of QoL in GERD-CCP. Conclusion: High levels of anxiety and depression may be more related to the poorer QoL in GERD patients with NCCP than those with CCP. This highlights the importance of evaluation and management of psychological impact for improving QoL in GERD-NCCP patients.
... Acid reflux stimulates the vagus nerve and triggers bronchoconstriction 21 , which could result in sleep disorders and affect mood disorders 22 . Third, the reflux symptom itself could result in depression if patients are constantly feeling upset about their condition 23 . ...
... Depression might also increase the risk of GERD. First, the fear of reflux symptoms might increase the individual's perception of reflux symptoms 23 . Psychological factors could reduce the sensation threshold in the body 23 and increase the sensation of esophageal stimulation 24 . ...
... First, the fear of reflux symptoms might increase the individual's perception of reflux symptoms 23 . Psychological factors could reduce the sensation threshold in the body 23 and increase the sensation of esophageal stimulation 24 . Second, depression might actually increase reflux. ...
Article
Full-text available
The purpose of this study is to evaluate the associations between gastroesophageal reflux disease (GERD) and depression using a national sample cohort of the Korean population. Data were collected from individuals ≥20 years old in the Korean National Health Insurance Service-National Sample Cohort between 2002 and 2013. We designed two different nested case-control studies. In study I, 60,957 participants with depression were matched at a 1:4 ratio with 243,828 controls, and their previous histories of GERD were analyzed. In study II, 133,089 participants with GERD were matched at a 1:2 ratio with 266,178 controls, and their previous histories of depression were analyzed. Crude and adjusted odds ratios (ORs) were analyzed using unconditional logistic regression analyses, and 95% confidence intervals (CIs) were calculated. Subgroup analyses were performed according to age and sex. The adjusted OR for GERD was 2.01 (95% CI = 1.96-2.07) in the patients with depression (study I). The adjusted OR for depression was 1.48 (95% CI = 1.43-1.52) in the patients with GERD (study II). The results of the subgroup analyses were consistent. GERD and depression displayed bidirectional associations.
... Moreover, when GERD occurs, acid reflux activates the autonomic nervous system and increases vagus nerve activation which causes bronchial constriction, leading to sleep disorders and mood disorders [25,31,32]. The risk of GERD may be increased by depression through reducing pressure on the lower esophageal sphincter and increasing gastric acid secretion [33]. Besides, it can also lower the threshold of sensation and increase sensitivity to the esophageal stimulation [33]. ...
... The risk of GERD may be increased by depression through reducing pressure on the lower esophageal sphincter and increasing gastric acid secretion [33]. Besides, it can also lower the threshold of sensation and increase sensitivity to the esophageal stimulation [33]. Antidepressant use may be another possible factor exacerbating reflux [34]. ...
Article
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Background: Observational research has found a bidirectional relationship between major depressive disorder and gastroesophageal reflux disease; however, the causal association of this relationship is undetermined. Aims: A bidirectional Mendelian randomization study was performed to explore the causal relationships between major depressive disorder and gastroesophageal reflux disease. Methods: For the instrumental variables of major depressive disorder and gastroesophageal reflux disease, 31 and 24 single-nucleotide polymorphisms without linkage disequilibrium (r2 ≤ 0.001) were selected from relevant genome-wide association studies, respectively, at the genome-wide significance level (p ≤ 5 × 10-8). We sorted summary-level genetic data for major depressive disorder, gastroesophageal reflux disease, gastroesophageal reflux disease without esophagitis, and reflux esophagitis from meta-analysis study of genome-wide association studies involving 173,005 individuals (59,851 cases and 113,154 non-cases), 385,276 individuals (80,265 cases and 305,011 non-cases), 463,010 individuals (4360 cases and 458,650 non-cases), and 383,916 individuals (12,567 cases and 371,349 non-cases), respectively. Results: Genetic liability to major depressive disorder was positively associated with gastroesophageal reflux disease and its subtypes. Per one-unit increase in log-transformed odds ratio of major depressive disorder, the odds ratio was 1.31 (95% confidence interval [CI], 1.19-1.43; p = 1.64 × 10-8) for gastroesophageal reflux disease, 1.51 (95% CI, 1.15-1.98; p = 0.003) for gastroesophageal reflux disease without esophagitis, and 1.21 (95% CI, 1.05-1.40; p = 0.010) for reflux esophagitis. Reverse-direction analysis suggested that genetic liability to gastroesophageal reflux disease was causally related to increasing risk of major depressive disorder. Per one-unit increase in log-transformed odds ratio of gastroesophageal reflux disease, the odds ratio of major depressive disorder was 1.28 (95% confidence interval, 1.11-1.47; p = 1.0 × 10-3). Conclusions: This Mendelian randomization study suggests a bidirectional causal relationship between major depressive disorder and gastroesophageal reflux disease.
... Patients with psychological 13 comorbidity often perceive low intensity oesophageal stimulation as being painful due to hypervigilance to 14 these intra-oesophageal events 68 . Psychological factors can decrease the pressure of the lower oesophageal 15 sphincter and change oesophageal motility 69 . The reflux symptom itself could result in depression if patients 16 are constantly feeling upset about their condition 69 . ...
... Psychological factors can decrease the pressure of the lower oesophageal 15 sphincter and change oesophageal motility 69 . The reflux symptom itself could result in depression if patients 16 are constantly feeling upset about their condition 69 . Second, the use of medications could mediate the effect. ...
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Genetic factors are recognised to contribute to common gastrointestinal (GI) diseases such as gastro-oesophageal reflux disease (GORD), peptic ulcer disease (PUD), irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). We conducted genome-wide association analyses based on 456,414 individuals and identified 27 independent and significant loci for GORD, PUD and IBS, including SNPs associated with PUD at or near genes MUC1 , FUT2 , PSCA and CCKBR , for which there are previously established roles in Helicobacter pylori infection, response to counteract infection-related damage, gastric acid secretion and gastrointestinal motility. Post-GWAS analyses implicate putative functional links between the nervous system and gastrointestinal tract for GORD, PUD and IBS, including the central nervous system, the enteric nervous system and their connection. Mendelian Randomisation analyses imply potentially bi-directional causality (the risk of GORD in liability to major depression and the risk of major depression in liability to GORD) or pleiotropic effect between them. A stronger genetic similarity among GORD, PUD and IBS than between these disorders and IBD is reported. These findings advance understanding the role of genetic variants in the etiology of GORD, PUD and IBS and add biological insights into the link between the nervous system and the gastrointestinal tract.
... Chronic stress, such as work-related stress, has been associated with a chronic state of hyperarousal or changes in hormone levels, impairing the immune system, that in turn may have an influence on tumor development (99,104,107). Further, there is a general perception that psychological stress plays a role in the development of gastrointestinal disorders, such as reflux, and these associations are being investigated actively (108,109). Few observational studies have evaluated possible associations between the psychosocial work environment and cancer risk (104, 107). There are no studies of the significance of a stressful work environment in the etiology of esophageal or gastric cardia adenocarcinoma, but some studies are available for other malignancies. ...
... The positive associations observed between low work pace satisfaction and risk of esophageal adenocarcinoma and squamous-cell carcinoma could be due to stress responses impairing the immune system, with a subsequently increased cancer risk (99,104,107). Further, as the association with esophageal adenocarcinoma disappeared when reflux symptoms were included in the model, one explanation could be an increased occurrence of reflux secondary to stress responses (108). ...
Article
Full-text available
ABSTRACT Adenocarcinoma of the esophagus and gastric cardia and squamous-cell carcinoma of the esophagus have a poor prognosis.The increasing incidence and the strong male predominance,of esophageal and cardia adenocarcinoma are striking, and yet unexplained, patterns that should be due to unknown environmental factors. The main aim of this thesis was to study occupational and socio-economic factors in relation to these tumors. Papers I, III and IV are based on a nationwide Swedish population-based case-control study
... 11,12 Furthermore, most previous research on GERD and affective disorders have been conducted in clinical settings in patients with a high-degree of comorbidity and consequent limited applicability to the general population. [13][14][15] Sleep disorders are common in the general population. 16,17 Previous research has similarly demonstrated an association between GERD and sleep disturbances, such as obstructive sleep apnea, daytime sleepiness, and insomnia. ...
... In the case of anxiety, we also did not find that anxiety medications increased the likelihood of GERD. While some studies suggest that anxiolytics may help with GERD through relaxation of lower esophageal tone, 14 others have demonstrated side effects, including reflux, associated with the commencement of anxiolytics for anxiety disorders. 11 Further work is required to understand the nature of the association between GERD and depression and anxiety medications. ...
Article
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Background & aim: Previous clinical studies have demonstrated a relationship between gastro-esophageal reflux disease (GERD) with anxiety and depression; however few population-based studies have controlled for sleep disorders. The current study aimed to assess the relationship between GERD and anxiety, depression, and sleep disorders in a community-based sample of Australian men. Methods: Participants comprised a sub-set of 1,612 men (mean age: 60.7 years, range: 35 - 80) who participated in the Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) Study during the years 2001-2012, who had complete GERD measures [Gastresophageal Reflux Disease Questionnaire (GerdQ)] and were not taking medications known to impact gastrointestinal function (excluding drugs taken for acid-related disorders). Current depression and anxiety were defined by (i) physician diagnosis, (ii) symptoms of depression (Beck Depression Inventory and Centre for Epidemiological Studies Depression Scale) or anxiety (Generalized Anxiety Disorder-7), and/or current depressive or anxiolytic medication use. Previous depression was indicated by past depressive diagnoses/medication use. Data on sleep quality, daytime sleepiness and obstructive sleep apnea were collected along with several health, lifestyle and medical factors, and these were systematically evaluated in both univariate and multivariable analyses. Results: Overall 13.7% (n = 221) men had clinically-significant GERD symptoms. In the adjusted models, an association between GERD and anxiety (OR 2.7; 95% CI 1.0 - 6.8) and poor sleep quality (OR 1.8; 95% CI 1.2 - 2.9) was observed, however no effect was observed for current depression (OR 1.5; 95% CI 0.8 - 2.7). After removing poor sleep quality from the model, an independent association between current depression (OR 2.6; 95% CI 1.7 - 3.8) and current anxiety (OR 3.2; 95% CI 1.8 - 6.0) and GERD was observed, but not for previous depression (OR 1.4; 95% CI 0.7 - 2.8). Conclusion: In this sample of urban-dwelling men, we observed a strong independent association between GERD, anxiety and current depression, the latter appearing to be partly mediated by poor sleep quality. Patients presenting with GERD should have concurrent mental health assessments in order to identify potential confounders to the successful management of their symptoms.
... The most common symptom of GERD is heartburn, which affects 7% of the total population (3). The study assumptions and general idea is that mental factors may play a role as a potential factor for GERD; for example, in a survey, 60% of patients with GERD reported exacerbation of symptoms at the time of exposure to mental factors (4). It means that minor psychostimulants may be perceived as the main symptoms by the patient; hence, mental factors may be the physiological function of the esophagus and the stomach. ...
... Since low responses to the proton inhibitor may be under the influence of socio-economic situations over mental disorder of patients, to get more reliable results, it is better to synchronize this factor among the groups. From the viewpoint of medicine, different treatments can be followed when the etiology of the disease is defined clearly (4,30). Therefore, further studies should be conducted to reveal more details in this regard. ...
Article
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Background Evidence shows an influence relationship between described symptoms of gastroesophageal reflux disorder (GERD) and emotional state. Objective To determine the relationship between anxiety and depression with GERD in patients referred to the endoscopy unit of Bouali-Sina Hospital in Qazvin. Methods This case-control study was conducted in the endoscopy unit of Bouali-Sina Hospital in Qazvin, Iran, from April 2014 through May 2015. Two hundred individuals (100 patients with GERD and 100 healthy individuals as a control group) were enrolled into the current study. All subjects completed the hospital anxiety and depression questionnaire. GERD was diagnosed based on the Los Angeles classification system. Demographic and socioeconomic characteristics in addition to clinical history of subjects were collected and analyzed using proper statistical methods (independent-samples t-test and AVOVA) and using SPSS version 22. Results Among the recruited patients, 50 subjects had erosive esophagitis (ERD) and 50 had non-erosive esophagitis (NERD). The anxiety score was significantly higher in the NERD group than the ERD and control groups (p=0.017; p<0.001). In addition, the anxiety score was significantly higher in the ERD group than the control group (p=0.014). The score of depression was higher in the NERD group than the ERD and the control groups. However, this difference was not statistically significant for the ERD group (p=0.63), but the difference was significant in comparison to the control group (p<0.001). There was no significant difference among the groups regarding age, gender or body mass index (BMI). The number of smokers was significantly higher in the ERD group than the NERD and control groups (p<0.001). Conclusion The current study showed that mental factors (anxiety and depression) play important roles in the development of GERD, especially NERD; therefore, it is recommended to consider these factors to select a suitable treatment plan.
... In the present study, we found that there is a strong association between psychological symptoms and the presence of LPR and GERD symptoms. The most commonly detected manifestations reported were anxiety, and there was a positive significant correlation with anxiety and a negative significant correlation between depression and reflux symptoms, and our result is in accordance with the pervious study Kamolz and Velanovich [22], which reported a strong association between psychological symptoms, mood disorders, anxiety, depression, and GERD-related symptoms in adults. A positive trend was observed when comparing current anxiety disorders and current GERD-related symptoms. ...
... There are many explanations for the association between psychopathology and GERD-related symptoms. As suggested Kamolz and Velanovich [22], the relationship may be contributed to changes in esophageal motility and LOS function in response to stressors. Although little is known about the morphological organization of serotonergic neurons in the esophagus, investigations have indicated that serotonin, the main target of both depression and anxiety treatment, plays a role in esophageal motility [23,24], leading to neurohormonal interaction between the central nervous system and the GI system. ...
... [14][15][16] Clinical studies have confirmed the association between psychosocial disorders and GERD. [17][18][19][20] GERD can lead to anxiety and depression, in turn, psychological disorders can also lead to reflux symptoms. 21,22 People with depression are 1.7 times more likely to develop GERD compared to those without depression. ...
... These factors often cause patients to feel hypersensitivity to internal organs; that is, pain sensation in response to stimulation below the threshold. 17 The specific mechanisms are as follows. First, the tight junctions of the esophageal epithelium of psychologically stressed rats are destroyed, thereby weakening or reducing the barrier function of the esophageal mucosa. ...
Article
Background/aims: The incidence of gastroesophageal reflux disease (GERD) is increasing annually. Studies have suggested that psychosocial disorders may be linked to the development of GERD. However, studies evaluating the association between psychosocial disorders and GERD have been inconsistent. Thus, we conducted a systematic review and meta-analysis of observational studies that evaluated the association between psychosocial disorders and GERD. Methods: We systematically searched the PubMed, Embase, Cochrane, and Web of Science databases until October 17, 2020. Pooled OR with 95% CI and subgroup analyses were calculated using a random-effects model. Subgroup analyses were performed to identify the sources of heterogeneity. Sensitivity analysis by one-study removal was used to test the robustness of our results. Results: This meta-analysis included 1 485 268 participants from 9 studies. Studies using psychosocial disorders as the outcome showed that patients with GERD had a higher incidence of psychosocial disorders compared to that in patients without GERD (OR, 2.57; 95% CI, 1.87-3.54; I2 = 93.8%; P < 0.001). Studies using GERD as an outcome showed an association between psychosocial disorders and an increased risk of GERD (OR, 2.23; 95% CI, 1.42-3.51; I2 = 97.1%; P < 0.001). The results of the subgroup analysis showed that the non-erosive reflux disease group had a higher increased risk of anxiety than erosive reflux disease group (OR, 9.45; 95% CI, 5.54- 16.13; I2 = 12.6%; P = 0.285). Conclusion: Results of our meta-analysis showed that psychosocial disorders are associated with GERD; there is an interaction between the two.
... Patients with psychological comorbidity often perceive low intensity esophageal stimulation as being painful due to hypervigilance to these intraesophageal events 85 . Psychological factors can decrease the pressure of the lower esophageal sphincter and change esophageal motility 90 . The reflux symptom itself could result in depression through potentially disabling effects on occupational or social function, or if patients are constantly feeling upset about their condition 90 . ...
... Psychological factors can decrease the pressure of the lower esophageal sphincter and change esophageal motility 90 . The reflux symptom itself could result in depression through potentially disabling effects on occupational or social function, or if patients are constantly feeling upset about their condition 90 . Use of medications could conceivably mediate bidirectional associations between depression and PG + M. Tricyclic antidepressants can lead to a decrease in lower esophageal sphincter pressure, and thus and increase in the number of reflux episodes (anticholinergic effect) 91 . ...
Article
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Genetic factors are recognized to contribute to peptic ulcer disease (PUD) and other gastrointestinal diseases, such as gastro-oesophageal reflux disease (GORD), irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). Here, genome-wide association study (GWAS) analyses based on 456,327 UK Biobank (UKB) individuals identify 8 independent and significant loci for PUD at, or near, genes MUC1, MUC6, FUT2, PSCA, ABO, CDX2, GAST and CCKBR. There are previously established roles in susceptibility to Helicobacter pylori infection, response to counteract infection-related damage, gastric acid secretion or gastrointestinal motility for these genes. Only two associations have been previously reported for duodenal ulcer, here replicated trans-ancestrally. The results highlight the role of host genetic susceptibility to infection. Post-GWAS analyses for PUD, GORD, IBS and IBD add insights into relationships between these gastrointestinal diseases and their relationships with depression, a commonly comorbid disorder.
... Multiple population-based studies have established a clear relationship between anxiety and gastrointestinal symptoms (Haug, Hu) [20,24]. Jansson et al. showed a 3.2-fold increased risk of reflux in patients with anxiety compared to those without, and studies continue to show a synergistic relationship between GERD and psychological disorders (Jansson et al. 2002) [23,25,26]. ...
... Kamolz and Velanovich published multiple studies using quality of life surveys to compare operative outcomes in patients who had psychological stressors to controls. They found that the improved quality of life after LARS was significant, but was attenuated compared to the control population (Velanovich 2003, Kamolz 2003, Kamolz 2002, Velanovich 2001 [27][28][29][30][31]. Investigations of similar cohorts that complained of recurrent reflux after LARS found that only a small minority had objective evidence of reflux on subsequent evaluation. Without a physiologic etiology for the recurrent reflux, the authors Taft et al. hypothesized that altered visceral anxiety, hypervigilance and symptom sensitivity act as catalysts for symptom production and can continuously modulate and confound patient experiences, partially explaining the disconnect between symptom severity and physiologic evidence of disease as well as failure to achieve satisfactory outcomes despite appropriate treatment (Taft) [10,11]. ...
Article
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Introduction Measures of mood and effective coping strategies have notable correlations with quality of life and treatment responses. There is evidence that patients with previously diagnosed anxiety disorders have less improvement in patient-reported outcome measures (PROMs) after laparoscopic anti-reflux surgery (LARS) and that objective pathology does not correlate well with symptom severity. We were interested in investigating whether anxiety and hypervigilance, as measured preoperatively with the esophageal hypervigilance anxiety scale (EHAS), is associated with the improvement in GERD-specific PROMs and EHAS scores 6 months after LARS. Methods We performed a retrospective cohort study of 102 adult patients (31% men, average age 64) who underwent LARS. In the preoperative evaluation, baseline gastroesophageal reflux disease-health-related quality of life (GERD-HRQL), laryngopharyngeal reflux symptom index (LPR-RSI) and EHAS scores were collected in addition to the standard reflux workup, including endoscopy, manometry, barium swallow, and pH study. For all three surveys, a higher score represents worse symptom severity. At 6 months postoperatively, 70 patients completed repeat GERD-HRQL, LPR-RSI, and EHAS surveys. We then analyzed for surgical and patient-related factors associated with improvement in the 6-month postoperative GERD-HRQL and LPR-RSI scores. Results There was a statistically significant decrease in the GERD-HRQL (25 vs. 2, p < 0.001), LPR-RSI (17 vs. 3, p < 0.001) and EHAS (34 vs. 15, p < 0.001) 6 months after LARS. On multivariable linear regression, a higher baseline EHAS score was independently associated with a greater improvement in GERD-HRQL (β 0.35, p < 0.001) and LPR-RSI (β 0.19, p = 0.03) 6-months after LARS. Additionally, the degree of improvement in EHAS, GERD-HRQL, and LPR-RSI was not influenced by the type of LARS performed or by the severity of disease. Conclusion These findings are consistent with literature suggesting that measures of psychoemotional health correlate better with symptom intensity than objective pathology. We found that patients with a higher EHAS score have greater symptom severity and lower quality of life at baseline. Novel findings to this study are that patients with a higher preoperative EHAS, a measure of psychoemotional health, actually benefitted more from surgery and not less, which has been the traditional view in the literature. Future studies are warranted to establish directionality and explore the role of preoperative cognitive behavioral therapy with LARS for patients with significant symptoms of hypervigilance and anxiety.
... Janson et al. was able to show a 3.2 fold increased risk of reflux in patients with anxiety compared to those without [26]. Studies continue to show a synergistic relationship between GERD and psychological disorders [27,28]. Kamolz et al. and Velanovich et al. used both quality of life surveys pre-operatively and post-operatively and compared patients who had psychological stressors to controls. ...
... Kamolz et al. and Velanovich et al. used both quality of life surveys pre-operatively and post-operatively and compared patients who had psychological stressors to controls. Both groups found that although ARS significantly improved quality of life in patients with psychological stressors it did so to a lesser extent than controls [11,12,[28][29][30][31]. Several studies expanded on this and examined patients who underwent ARS and continued to have reflux symptoms and found that a minority of these patients actually had objective evidence of reflux as the etiology of their continued symptoms, suggesting patient perception as the cause of their continued reflux symptoms [32,33]. ...
Article
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Patient-reported outcomes (PROs) are integral to determining the success of foregut surgical interventions and psychoemotional factors have been hypothesized to impact the quality of life of patients. This study evaluates the correlation between PROs—specifically the Gastroesophageal Reflux Disease-Health-Related Quality of Life (GERD-HRQL) and the Laryngopharangeal Reflux Symptom Index (LPR-RSI)—and the recently validated Esophageal Hypervigilance Anxiety Scale (EHAS). We hypothesize that patients with higher EHAS scores have significantly elevated GERD-HRQL LPR-RSI compared to those with normal scores. EHAS has been developed and validated in chronic esophageal disorders, but clinical impact is unknown. In this retrospective study, 197 patients (38% men, average age 56 ± 16) completed the following surveys:(1) EHAS, (2) GERD-HRQL, and (3) LPR-RSI. All patients referred for surgical evaluation of GERD completed the surveys as part of their pre-operative workup and post-operative follow-up In bivariate analysis, EHAS correlated with both GERD-HRQL (r 0.53, P = <0.001) and LPR-RSI (r 0.36, P = 0.009). Accounting for potential confounding with sex and age in multivariable linear regression models, a higher GERD-HRQL score (β 0.38; 95% CI 0.29 to 0.48; P = <0.001; Semipartial R² 0.20) and a higher LPR-RSI score (β 0.21; 95% CI 0.13 to 0.29; P = <0.001; Semipartial R² 0.08) were independently associated with higher EHAS. The observed relationship between mental health and GERD symptom intensity is consistent with the biopsychosocial paradigm of illness. Future studies focused on post-surgical outcomes following the incorporation of EHAS into perioperative care is needed to evaluate its effectiveness as a clinical decision support tool in ARS.
... Furthermore, low conscientiousness and high neuroticism were identified as significant vulnerability factors for respiratory problems, even when accounting for smoking, physical activity and comorbid chronic diseases such as cardiovascular and psychiatric disorders [59][60][61]. Neuroticism also contributes to the severity of GERD symptoms [62][63][64]. This suggests that personality characteristics related to neuroticism and conscientiousness may play a role in the severity of hallmark physical conditions affecting WTC responders. ...
Article
Background Personality is a major predictor of many mental and physical disorders, but its contributions to illness course are understudied. Purpose The current study aimed to explore whether personality is associated with a course of psychiatric and medical illness over 10 years following trauma. Methods World Trade Center (WTC) responders (N = 532) completed the personality inventory for DSM-5, which measures both broad domains and narrow facets. Responders’ mental and physical health was assessed in the decade following the WTC disaster during annual monitoring visits at a WTC Health Program clinic. Multilevel modeling was used in an exploratory manner to chart the course of health and functioning, and examine associations of maladaptive personality domains and facets with intercepts (initial illness) and slopes (course) of illness trajectories. Results Three maladaptive personality domains—negative affectivity, detachment and psychoticism—were uniquely associated with initial posttraumatic stress disorder (PTSD); detachment and psychoticism were also associated with initial functional impairment. Five facets—emotional lability, anhedonia, callousness, distractibility and perceptual dysregulation—were uniquely associated with initial mental and physical health and functional impairment. Anxiousness and depressivity facets were associated with worse initial levels of psychiatric outcomes only. With regard to illness trajectory, callousness and perceptual dysregulation were associated with the increase in PTSD symptoms. Anxiousness was associated with greater persistence of respiratory symptoms. Conclusions Several personality domains and facets were associated with initial levels and long-term course of illness and functional impairment in a traumatized population. Results inform the role of maladaptive personality in the development and maintenance of chronic mental-physical comorbidity. Personality might constitute a transdiagnostic prognostic and treatment target.
... Animal studies have reported that the combination of gastric content and bile acids is very injurious to the larynx, whereas human studies demonstrated that acid exposure reaching proximal esophagus is significantly increased in patients with laryngeal disorders [27,28]. However, the presence of extra-esophageal symptoms of GERD in the absence of endoscopic signs of esophageal mucosal break suggests that factors other than acid reflux, such as esophageal mucosal sensitivity, abnormal esophageal contraction, and psychological factors may cause extra-esophageal reflux symptoms [29,30]. ...
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Introduction Erosive reflux esophagitis caused a large clinical spectrum of symptoms. Our aim was to assess the prevalence of extra-esophageal symptoms in individuals with and those without erosive esophagitis in Albania. Methods A case–control study was conducted at the Regional Hospital of Durres, the second main district in Albania, a transitional country in South Eastern Europe, including 248 patients with erosive esophagitis (aged 46.5 ± 16.3 years) and 273 controls (aged 46.4 ± 16.0 years; response rate: 70%) enrolled during the period January 2013–June 2014. Both cases and controls underwent upper endoscopy. Information on socio-demographic characteristics and lifestyle factors was also collected. Binary logistic regression was used to assess the association of erosive esophagitis and extra-esophageal symptoms. Results Patients with erosive esophagitis had a higher prevalence of excessive alcohol consumption, smoking, sedentarity, non-Mediterranean diet and obesity compared to their control counterparts (9% vs. 5%, 70% vs. 49%, 31% vs. 17%, 61% vs. 49% and 22% vs. 9%, respectively). Upon adjustment for all socio-demographic characteristics and lifestyle/behavioral factors, there was evidence of a strong association of erosive esophagitis with chronic cough (OR = 3.2, 95% CI = 1.7–5.8), and even more so with laryngeal disorders (OR = 4.4, 95% CI = 2.6–7.5). In all models, the association of erosive esophagitis with any extra-esophageal symptoms was strong and mainly consistent with each of the symptoms separately (fully-adjusted model: OR = 4.6, 95% CI = 2.9–7.3). Conclusion Our findings indicate that the prevalence of extra-esophageal symptoms is higher among patients with erosive esophagitis in a transitional country characterized conventionally by employment of a Mediterranean diet.
... As every chronic disease it decreases one's frame of mind and causes many negative emotions. It is a source of stress and influences psychosocial functioning of patients affected by this disease (8,9). ...
Article
Introduction: Diseases of the digestive system are still a serious therapeutic problem due to their frequency and problems associated with their treatment. Psychosomatic studies indicate that psychological factors play an important role in the development, clinical course and treatment of these disorders. Aim of study: The presented objective was finding the answer to the question: Are there any differences in the intensity of selected psychological variables between patients with irritable bowel syndrome (IBS) and gastroesophageal reflux disease (GERD)? Moreover, the authors evaluated the influence of selected psychological factors on the course of these diseases. Material and methods: 45 patients were enrolled in the study, 21 with diagnosed IBS and 24 with diagnosed GERD. Among studied variables there were the following psychological aspects: stress and styles of coping with stress, anxiety as a currently experienced condition and as permanent personality feature and selected aspects of emotional control. The following methods were used: a medical questionnaire developed by the authors and 4 standardised psychological tests: S. Cohen's Perceived Stress Scal, Moos' Questionnaire of Coping with Stress Situation, J. Brzeziński's Control of Emotions Questionnaire and Spielberger's Self-evaluation questionnaire (Inventory of Anxiety as a State and as a Feature). Results: Studied patients were not statistically different in terms of selected psychological aspects. However, analyzed psychological variables coexisted with the intensity of selected somatic ailments in IBS and in GERD. Conclusions: Both diseases are strongly associated with the functioning of the nervous system and with mental sphere of every man. Analyzed psychological factors do not differentiate examined diseases of the digestive tract and therefore may confirm the hypothesis that stress is a non-specific reaction of an organism.
... Still, the correlation between the severity of symptoms of GERD and pathophysiological abnormalities is not significant. This supports the concept that psychological factors strongly affect GERD symptoms [31,33]. Limited studies globally have been investigating the relationship between depression and anxiety and GERD symptoms; however, no constant outcome from those studies [31,34]. ...
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ABSTRACT Introduction: The correlation between psychological factors and digestive abnormalities is significant, yet, the entire mechanism still undetermined.Objectives:Our study aimed to study the correlation between anxiety, depression, and GERD among health specialties students in Makkah city, Saudi Arabia (KSA). Methods: a survey-based study was demonstrated among health-related students in different medical colleges at Umm Al-Qura University in the period time between December 2020 and January 2021. GERD symptom frequency was evaluated using a previouslyvalidated gastroesophageal reflux symptom questionnaire GERD-Q; however, depressive and anxious symptoms were assessed using a Hospital Anxiety/Depression Scale (HADS). Result:A total of 353 students participated in the current study. The mean age of participants in the present study was 22.69 ± 2.27. Male participants represents the predominant of replying. The majority of respondents were 2nd-year students. There is a significant correlation between anxiety and depression among students with GERD (P-value, 0.001), (P-value, 0.017), respectively. Conclusions: Depression and anxiety represent a significant factor in correlation with students with GERD. Keyword: predictors, anxiety, depression, GERD, health students, Saudi Arabia.
... on the other hand, we found vocal fold nodules in only 7.1% of teachers; in previous reports, the prevalence has ranged from 6% to 14% 11 30 32 33 . notably, 35.5% of teachers presented clinical symptoms of gastro-oesophageal reflux, compared with only 2.7% of controls; since gastro-oesophageal reflux may be potentiated by psychological stress 34 , it is likely that emotional factors may play a role in this finding. Although previous papers have identified several cofactors for increased risk of voice disorders 14 29 32 , smoking, coffee and stress, in our sample none of these factors correlated with laryngostroboscopic abnormalities. in contrast, we found that job-related stress correlated with the duration of teaching, and it should be noted that a high proportion of teachers referred that voice disorders interfered with their emotional state and social activities. in our sample, vocal fold disorders were not correlated with years of teaching, and teachers with fewer years of teaching presented a higher rate of abnormalities than subjects with a longer job activity. ...
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Previous reports focusing on the high prevalence of voice disorders in teachers have suggested that vocal loading might be the main causal factor. The aim of our study was to assess the prevalence of voice disorders in a sample of primary school teachers and evaluate possible cofactors. Our sample was composed of 157 teachers (155 females, mean age 46 years). Participants were asked to complete two selfadministrated questionnaires: one with clinical data, and the second an Italian validated translation of VHI (voice handicap index). On the same day they also underwent a laryngostroboscopic exam and logopedic evaluation. The results were compared with those of a control group composed of accompanying individuals. Teachers presented a higher rate of abnormalities at laryngostroboscopic examination than the control group (51.6% vs. 16%, respectively). Among these, 7.1% presented nodules. In our sample, vocal fold disorders were not correlated with years of teaching, smoking, coffee consumption, or levels of anxiety. Our findings are in agreement with previous reports on the prevalence of pathologic disorders among teachers; nonetheless, the prevalence of nodules was lower than in previous investigations, and voice loading was not correlated with laryngostroboscopic findings. Current Italian law does not include any guidance regarding voice education and screening in subjects with high vocal loading. Our work stresses the need for such legislation.
... Frequency of heartburn in cases of specific psychiatric disorders.7 ...
... Animal studies have reported that the combination of gastric content and bile acids is very injurious to the larynx, whereas human studies demonstrated that acid exposure reaching proximal esophagus is signi cantly increased in patients with laryngeal disorders [27,28]. However, the presence of extra-esophageal symptoms of GERD in the absence of endoscopic signs of esophageal mucosal break suggests that factors other than acid re ux, such as esophageal mucosal sensitivity, abnormal esophageal contraction, and psychological factors may cause extra-esophageal re ux symptoms [29,30]. ...
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Introduction: Erosive reflux esophagitis caused a large clinical spectrum of symptoms. Our aim was to assess the prevalence of extra-esophageal symptoms in individuals with and those without erosive esophagitis in Albania. Methods: A case-control study was conducted at the Regional Hospital of Durres, the second main district in Albania, a transitional country in South Eastern Europe, including 248 patients with erosive esophagitis (aged 46.5±16.3 years) and 273 controls (aged 46.4±16.0 years; response rate: 70%) enrolled during the period January 2013 – June 2014. Both cases and controls underwent upper endoscopy. Information on socio-demographic characteristics and lifestyle factors was also collected. Binary logistic regression was used to assess the association of erosive esophagitis and extra-esophageal symptoms. Results: Patients with erosive esophagitis had a higher prevalence of excessive alcohol consumption, smoking, sedentarity, non-Mediterranean diet and obesity compared to their control counterparts (9% vs. 5%, 70% vs. 49%, 31% vs. 17%, 61% vs. 49% and 22% vs. 9%, respectively). Upon adjustment for all socio-demographic characteristics and lifestyle/behavioral factors, there was evidence of a strong association of erosive esophagitis with chronic cough (OR=3.2, 95%CI=1.7-5.8), and even more so with laryngeal disorders (OR=4.4, 95%CI=2.6-7.5). In all models, the association of erosive esophagitis with any extra-esophageal symptoms was strong and mainly consistent with each of the symptoms separately (fully-adjusted model: OR=4.6, 95%CI=2.9-7.3). Conclusion: Our findings indicate that the prevalence of extra-esophageal symptoms is higher among patients with erosive esophagitis in a transitional country characterized conventionally by employment of a Mediterranean diet.
... Research demonstrated that heartburn and other gastro-esophageal reflux disease (GERD) symptoms experienced during the night commonly cause sleep disturbances and that patients with dyspepsia or heartburn scored higher with regard to anxiety and depression. In addition, some studies have suggested that psychological factors such as anxiety and depression play a part in the development of GERD [23,24]. In the present study, however, we did neither find any significant difference in the total sleep quality scores of the two group of patients, nor in their anxiety and depression scores. ...
Article
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Aim of the study was to evaluate sleep quality in a small sample of patients with gastro-esophageal reflux disease (GERD) comparing them with the patients under treatment in oncology department. Forty-eight patients were included in the study, 22 of them were recruited from the oncology department (oncology patients: OnPs) and 26 from the gastroenterology department (gastroenterology patients: GEPs) at a university hospital. By senior psychology students, the Hospital Anxiety and Depression Scale and the Pittsburg Sleep Quality Index were administered to the patients. There was no significant difference between the two groups regarding anxiety and depression scores of the patients and their total sleep quality scores. Nevertheless, it has been found that GEPs had higher anxiety scores than OnPs. The regression analysis demonstrated that sleep quality scores are determined only by anxiety scores and that being an oncology or gastroenterology patients, being at a certain age, or gender have no effect on total sleep quality scores.
... Experimental studies show that acute stress can increase the secretion of gastric acid, slow down and delay the gastric emptying, and cause the reflux of gastric contents into the esophagus. About 60% of patients suffering from GERD believe that they show more symptoms of the disease when faced with stress (9)(10)(11). Malekzadeh and co-workers carried out a study in which they reported stress to be a risk factor for GERD (12). ...
Article
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Background: GastroEsophageal Reflux Disease (GERD) is the most common gastrointestinal disorders, which may be caused or aggravated by occupational stress. In this study we aimed to investigate the prevalence of GERD in nurses working in hospitals of a province in Iran and assessing its relationship with their occupational stress. Materials and Methods: The study was a cross-sectional and correlational one. The study population included all nurses working in public hospitals of a province in Iran in 2016. The stratified random sampling was used. The data were collected using Nursing Stress Scale (NSS) and Gastroesophageal Reflux Disease Questionnaire. The SPSS software version 22 and independent t, Chi-square, and Mann-Whitney tests were used for data analysis. Results: The prevalence of GERD and severe levels of occupational stress among nurses were 26.8%, and 25.9%, respectively. Statistical analyses showed no significant correlation between occupational stress and the risk of GERD, but a significant relation was found between the sex of the nurses and their occupational stress and between their type of employment and the risks of GERD. Conclusion: The prevalence of GERD among nurses had no significant difference with that in the general community. Although nursing is considered as a stressful job, it seems that nurses adapt themselves with the working conditions after a while and experience stress levels similar to other people in the community.
... 35 Moreover, anxiety and depression can lead to hypochondriasis, which indirectly lowers the threshold of reflux perception and exaggerates the sensation of reflux symptoms compared to that observed in controls. 36,37 In a previous study, anxiety and depression levels did not significantly affect the acid exposure time and the number of reflux episodes, although the severity of reflux symptoms showed a significant association with anxiety levels in patients with GERD. 14 Conversely, reflux symptoms may cause anxiety and depression. ...
Article
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Background/Aims The different clinical manifestations of gastroesophageal reflux disease (GERD) may be influenced by associated psychological factors. We evaluated the psychological status (anxiety and depression) according to each subtype of GERD. Methods Subjects who underwent esophagogastroduodenoscopy and completed a symptom questionnaire between January 2008 and December 2011 were analyzed. The subjects were classified into the following groups: erosive reflux disease (ERD), non-erosive reflux disease (NERD), asymptomatic erosive esophagitis (AEE), and controls. Anxiety and depression were assessed using the State-Trait Anxiety Inventory and Beck Depression Inventory, respectively. Results We analyzed 19 099 subjects: 16 157 (84.6%), 176 (0.9%), 1398 (7.3%), and 1368 (7.2%) in the control, ERD, NERD, and AEE groups, respectively. Multiple multinomial logistic regression revealed a significant association of increased state (adjusted OR, 1.89; 95% CI, 1.53–2.33) and trait anxiety (adjusted OR, 1.78; 95% CI, 1.34–2.35) and depression (adjusted OR, 2.21; 95% CI, 1.75–2.80) with NERD. ERD group showed a significant association only with state anxiety (adjusted OR, 2.20; 95% CI, 1.27–3.81) and depression (adjusted OR, 2.23; 95% CI, 1.18–4.22). The AEE group, however, did not show any significant association with psychological factors. Conclusion This cross-sectional study revealed that anxiety and depression levels were significantly higher in subjects with GERD (notably in the NERD) than in controls.
... En un estudio similar, Potts y Bass 38 también siguieron a 46 pacientes durante 11 años, y de estos solo el 4.3% murieron de causa cardiovascular, aunque igualmente el 74% reportaron continuar con dolor a lo largo de todo el seguimiento. La comorbilidad psiquiátrica como estrés, ansiedad y depresión son más prevalentes en los pacientes con ERGE, y aproximadamente el 60% reportan empeoramiento de sus síntomas durante episodios de estrés, lo cual se relaciona con aumento en la percepción de los mismos 39 . Se ha documentado que las comorbilidades psicológicas llevan al paciente a un estado de hipervigilancia de las sensaciones, lo que puede llevar a una respuesta incrementada a un estímulo, o a un aumento o empeoramiento en la intensidad del dolor 40,41 . ...
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Resumen: Introducción: Dolor torácico no cardíaco (DTNC) se define como un síndrome clínico caracterizado por dolor retroesternal semejante a la angina de pecho, pero de origen no cardiaco y generado por enfermedades esofágicas, osteomusculares, pulmonares o psiquiátricas. Objetivo: Presentar una revisión consensuada basada en evidencias sobre definición, epidemiología, fisiopatología, diagnóstico y opciones terapéuticas para pacientes con DTNC. Métodos: Tres coordinadores generales realizaron una revisión bibliográfica de todas las publicaciones en inglés y español sobre el tema y elaboraron 38 enunciados iniciales divididos en tres categorías principales: 1) definiciones, epidemiología y fisiopatología; 2) diagnóstico, y 3) tratamiento. Los enunciados fueron votados (3 rondas) utilizando el sistema Delphi, y los que alcanzaron un acuerdo > 75% fueron considerados y calificados de acuerdo con el sistema GRADE. Resultados y conclusiones: El consenso final incluyó 29 enunciados Todo paciente que debuta con dolor torácico debe ser inicialmente evaluado por un cardiólogo. La causa más común de DTNC es la enfermedad por reflujo gastroesofágico (ERGE). Como abordaje inicial, si no existen síntomas de alarma, se puede dar una prueba terapéutica con inhibidor de bomba de protones (IBP) por 2-4 semanas. Si hay disfagia o síntomas de alarma, se recomienda hacer una endoscopia. La manometría de alta resolución es el mejor método para descartar trastornos motores espásticos y acalasia. La pHmetría ayuda a demostrar exposición esofágica anormal al ácido. El tratamiento debe ser dirigido al mecanismo fisiopatológico, y puede incluir IBP, neuromoduladores y/o relajantes de músculo liso, intervención psicológica y/o terapia cognitiva, y ocasionalmente cirugía o terapia endoscópica. Abstract: Introduction: Non-cardiac chest pain is defined as a clinical syndrome characterized by retrosternal pain similar to that of angina pectoris, but of non-cardiac origin and produced by esophageal, musculoskeletal, pulmonary, or psychiatric diseases. Aim: To present a consensus review based on evidence regarding the definition, epidemiology, pathophysiology, and diagnosis of non-cardiac chest pain, as well as the therapeutic options for those patients. Methods: Three general coordinators carried out a literature review of all articles published in English and Spanish on the theme and formulated 38 initial statements, dividing them into 3 main categories: (i) definitions, epidemiology, and pathophysiology; (ii) diagnosis, and (iii) treatment. The statements underwent 3 rounds of voting, utilizing the Delphi system. The final statements were those that reached > 75% agreement, and they were rated utilizing the GRADE system. Results and conclusions: The final consensus included 29 statements. All patients presenting with chest pain should initially be evaluated by a cardiologist. The most common cause of non-cardiac chest pain is gastroesophageal reflux disease. If there are no alarm symptoms, the initial approach should be a therapeutic trial with a proton pump inhibitor for 2-4 weeks. If dysphagia or alarm symptoms are present, endoscopy is recommended. High-resolution manometry is the best method for ruling out spastic motor disorders and achalasia and pH monitoring aids in demonstrating abnormal esophageal acid exposure. Treatment should be directed at the pathophysiologic mechanism. It can include proton pump inhibitors, neuromodulators and/or smooth muscle relaxants, psychologic intervention and/or cognitive therapy, and occasionally surgery or endoscopic therapy. Palabras clave: Dolor, Torácico, No cardíaco, ERGE, Trastornos motores esofágicos, México, Keywords: Pain, Chest, Non-cardiac, GERD, Esophageal motor disorders, Mexico
... En un estudio similar, Potts y Bass 38 también siguieron a 46 pacientes durante 11 años, y de estos solo el 4.3% murieron de causa cardiovascular, aunque igualmente el 74% reportaron continuar con dolor a lo largo de todo el seguimiento. La comorbilidad psiquiátrica como estrés, ansiedad y depresión son más prevalentes en los pacientes con ERGE, y aproximadamente el 60% reportan empeoramiento de sus síntomas durante episodios de estrés, lo cual se relaciona con aumento en la percepción de los mismos 39 . Se ha documentado que las comorbilidades psicológicas llevan al paciente a un estado de hipervigilancia de las sensaciones, lo que puede llevar a una respuesta incrementada a un estímulo, o a un aumento o empeoramiento en la intensidad del dolor 40,41 . ...
Article
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Introduction: Non-cardiac chest pain is defined as a clinical syndrome characterized by retrosternal pain similar to that of angina pectoris, but of non-cardiac origin and produced by esophageal, musculoskeletal, pulmonary, or psychiatric diseases. Aim: To present a consensus review based on evidence regarding the definition, epidemiology, pathophysiology, and diagnosis of non-cardiac chest pain, as well as the therapeutic options for those patients. Methods: Three general coordinators carried out a literature review of all articles published in English and Spanish on the theme and formulated 38 initial statements, dividing them into 3 main categories: (i) definitions, epidemiology, and pathophysiology; (ii) diagnosis, and (iii) treatment. The statements underwent 3 rounds of voting, utilizing the Delphi system. The final statements were those that reached > 75% agreement, and they were rated utilizing the GRADE system. Results and conclusions: The final consensus included 29 statements. All patients presenting with chest pain should initially be evaluated by a cardiologist. The most common cause of non-cardiac chest pain is gastroesophageal reflux disease. If there are no alarm symptoms, the initial approach should be a therapeutic trial with a proton pump inhibitor for 2-4 weeks. If dysphagia or alarm symptoms are present, endoscopy is recommended. High-resolution manometry is the best method for ruling out spastic motor disorders and achalasia and pH monitoring aids in demonstrating abnormal esophageal acid exposure. Treatment should be directed at the pathophysiologic mechanism. It can include proton pump inhibitors, neuromodulators and/or smooth muscle relaxants, psychologic intervention and/or cognitive therapy, and occasionally surgery or endoscopic therapy. Resumen: Introducción: Dolor torácico no cardíaco (DTNC) se define como un síndrome clínico caracterizado por dolor retroesternal semejante a la angina de pecho, pero de origen no cardiaco y generado por enfermedades esofágicas, osteomusculares, pulmonares o psiquiátricas. Objetivo: Presentar una revisión consensuada basada en evidencias sobre definición, epidemiología, fisiopatología, diagnóstico y opciones terapéuticas para pacientes con DTNC. Métodos: Tres coordinadores generales realizaron una revisión bibliográfica de todas las publicaciones en inglés y español sobre el tema y elaboraron 38 enunciados iniciales divididos en tres categorías principales: 1) definiciones, epidemiología y fisiopatología; 2) diagnóstico, y 3) tratamiento. Los enunciados fueron votados (3 rondas) utilizando el sistema Delphi, y los que alcanzaron un acuerdo > 75% fueron considerados y calificados de acuerdo con el sistema GRADE. Resultados y conclusiones: El consenso final incluyó 29 enunciados Todo paciente que debuta con dolor torácico debe ser inicialmente evaluado por un cardiólogo. La causa más común de DTNC es la enfermedad por reflujo gastroesofágico (ERGE). Como abordaje inicial, si no existen síntomas de alarma, se puede dar una prueba terapéutica con inhibidor de bomba de protones (IBP) por 2-4 semanas. Si hay disfagia o síntomas de alarma, se recomienda hacer una endoscopia. La manometría de alta resolución es el mejor método para descartar trastornos motores espásticos y acalasia. La pHmetría ayuda a demostrar exposición esofágica anormal al ácido. El tratamiento debe ser dirigido al mecanismo fisiopatológico, y puede incluir IBP, neuromoduladores y/o relajantes de músculo liso, intervención psicológica y/o terapia cognitiva, y ocasionalmente cirugía o terapia endoscópica. Keywords: Pain, Chest, Non-cardiac, GERD, Esophageal motor disorders, Mexico, Palabras clave: Dolor, Torácico, No cardíaco, ERGE, Trastornos motores esofágicos, México
... Exposure to stress increases the secretion of gastric acid, slows and delays the gastric emptying, and causes the reflux [8]. Moreover, previous study reported that most of patients with GERD suffered exaggerated symptoms when faced stressful events [27]. ...
Article
Full-text available
Background: Gastroesophageal reflux disease (GERD) is a worldwide prevalent gastrointestinal disorder which has negative impacts on quality of life, health and economy. The aims of this study were to assess the prevalence of GERD among college students in southwestern Saudi Arabia and to evaluate its personal, academic and stress correlates. Materials and methods: Through a cross-sectional study design, a self-reported questionnaire was distributed between a representative sample of students in health and non-health care colleges in southwestern Saudi Arabia. The questionnaire included data for personal characteristics, academic study, and Arabic versions of GERD questionnaire (GerdQ) and Cohen's Perceived Stress Scale. Results: Out of 2878 studied students, GERD was reported by 28.6% and 36.6% of students in health and non-health care colleges respectively with an overall prevalence rate of 33.18%. It was associated with impacts on daily life in 17.2% of students. By multivariable regression analysis, GERD was significantly higher among males (aOR = 1.44, 95% CI:117-1.65), ex-smokers (aOR = 1.87), current smokers (aOR = 1.71), non-health care students (aOR = 1.36) and those exposed to high perceived stress (aOR = 1.30). Conclusion: GERD is a prevalent problem among college students in southwestern Saudi Arabia as it affects about one third of the students. Considering high prevalence of GERD, associated daily life impacts, young age of the studied subject and the risk of future complications, this condition could represent a challenging health and economic problem. The risk of GERD is higher among; males, smokers, former smokers, non-health care colleges students and subjects exposed to high perceived stress.
... However, there was no significant association between the severity of symptoms of GERD and pathophysiological irregularities as identified by 24-hour pH and esophageal manometry. This supports the concept that GERD symptoms are greatly influenced by psychological factors [7]. To the best of our knowledge, few published global reports establish a relationship between psychological factors, including depression and anxiety, and GERD symptoms to date and the outcomes of those studies are not consistent [8]. ...
Article
Introduction Gastroesophageal reflux disease (GERD) influences patients' general health, daily and social functioning, and physical and emotional activities. It strongly affects the health-related quality of life with frequent interruptions during sleep, work, and social activities. GERD is defined as a condition that develops when the reflux of stomach contents causes troublesome symptoms and/or complications. GERD symptoms are a major concern for many patients, as they cause a disturbance in physical, social and emotional health. In this study, we determine the prevalence of anxiety and depression in patients with GERD with and without chest pain. Methods In this cross-sectional study, a total of 258 consecutive patients with a diagnosis of GERD were included in this study. Of 258 participants, 112 had concerns about chest pain. Clinical presentations and comorbid disorders were evaluated by a previously validated gastroesophageal reflux symptom questionnaire. Depressive and anxious symptoms were assessed using a Hospital Anxiety/Depression Scale. Results A total of 107 (41.4%) participants had depression, 89 (34.4%) participants had anxiety, and 70 (27.13%) had both depression and anxiety. Depression and anxiety were significantly higher in patients with GERD and chest pain. Conclusion Anxiety and depression were significantly higher in patients with GERD, particularly those who also reported concerns of chest pain. Measures should be taken to reduce the stress and anxiety of GERD patients to cope with their daily life activities and improve their quality of life.
Objective: Selective serotonin reuptake inhibitors (SSRIs) induce some adverse effects on gastrointestinal system. We aimed to investigate the role of citalopram, a well-known SSRI, on the reflux symptoms. Methods: Seventy patients with gastro-oesophageal reflux disease (GERD) were included to the study. Anxiety and depressive symptoms were measured with the Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI), version II, respectively. Participants were divided into two groups: Group 1 (n=35) treated with only esomeprazole + sodium alginate and Group 2 (n=35) who were classified as moderate-severe depression and/or anxiety treated with esomeprazole + sodium alginate + citalopram. Results: At the beginning, BDS and BAS were significantly higher in Group 2 than in Group 1 (both p<0.001) and BAS and BDS were significantly decreased with the treatments in both groups (both p<0.001). Moreover, the numbers of the patient who said the reflux symptoms improved were significantly higher in Group 1 than in Group 2 (p=0.001). Conclusions: The administration of citalopram to patients with GERD caused the distribution of recovery of the reflux symp - toms. This relation should be taken into account when managing depression in the patients with severe reflux symptoms.
Article
Surgical management of gastroesophageal reflux disease has evolved from relatively invasive procedures requiring open laparotomy or thoracotomy to minimally invasive laparoscopic techniques. Although side effects may still occur, with careful patient selection and good technique, the overall symptomatic control leads to satisfaction rates in the 90% range. Unfortunately, the next evolution to endoluminal techniques has not been as successful. Reliable devices are still awaited that consistently produce long-term symptomatic relief with correction of pathologic reflux. However, newer laparoscopically placed devices hold promise in achieving equivalent symptomatic relief with fewer side effects. Clinical trials are still forthcoming.
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This population study was performed among adult residents of Tehran, Iran in 2013. We invited high school and university educated healthy appearing subjects who were members of a health surveillance study in district number 11 of Tehran to reply to the GPWB query. Participants were divided into two groups, GERD patients and controls. We compared the dimensions of GPWB among these two groups. Results: A total of 135 persons with a mean age of 35.5 ± 13 years were recruited for study participation. Approximately 30% of men and 23% of women had at least weekly GERD symptoms. Anxiety was significantly more common among GERD patients than controls. General health and positive well-being were significantly impaired among GERD patients. Conclusion: Assessment of self-representation of wellbeing and distress in GERD patients and consideration of new, relevant therapeutic avenues are important for the control of GERD.
Article
Gastroesophageal reflux disease (GERD) is a common physical disease among psychiatric patients. We conducted this study to investigate the prevalence and risk of GERD in patients with major depressive disorder (MDD) in Taiwan. We conducted a cross-sectional study using the National Health Insurance Research Database in Taiwan. The study subjects included 4790 patients with MDD and 728,749 people in the general population during 2005. Distributions of GERD as well as age, gender, income, region of residence, and medical comorbidities, such as diabetes mellitus, hypertension, renal disease, hyperlipidemia, and ischemic heart disease, in the 2 groups were examined by χ(2)-tests. Multivariate logistic regression models were used to analyze the associations between MDD and GERD. The 1-year prevalence rates of GERD in patients with MDD and the general population were 3.75% and 1.05%, respectively. The prevalence rate of GERD was significantly higher in patients with MDD in all age, sex, insurance amount, region, and urbanicity subgroups (all p < 0.001). The multivariate logistic regression analysis showed that patients with MDD were significantly associated with an increased rate for GERD ([Odds Ratio] = 3.16; 95% Confidence Interval = 2.71-3.68; p < 0.001). The prevalence of GERD was significantly higher in patients with MDD. In clinical practice, psychiatrists should pay attention to the possibility of GERD symptoms, such as heartburn, regurgitation, or dysphagia, and should consider consulting Gastroenterology specialists when clinically indicated.
Article
Background: Nonerosive reflux disease (NERD) is detected frequently. Furthermore, as general checkups including endoscopy have become popular, silent erosive esophagitis (EE), which is defined as EE without the typical symptoms of gastroesophageal reflux disease (GERD), is also frequently encountered. We investigated the determinants of symptom presentation in symptomatic EE, NERD, and silent EE, which are representative GERD groups. Materials and methods: Participants in a prospective health-screening cohort underwent upper endoscopy from June 2009 to September 2010. GERD was defined as heartburn and/or acid regurgitation at least weekly or EE by endoscopy. All participants were asked to complete a validated questionnaire, which included questions about gastrointestinal symptoms and the somatization symptom checklist (SSC). Results: Among 4565 participants (men, 51.9%; mean age, 46.0±10.2 years), GERD was found in 678 participants (14.9%) and EE in 335 participants (7.3%). Each group of participants was classified into the following three categories: (i) symptomatic EE (n=38, 5.6%); (ii) NERD (n=343, 50.6%); and (iii) silent EE (n=297, 43.8%). Male sex and obesity were common predictors in both the symptomatic and the silent EE groups compared with the control group. Higher scores on the SSC [odds ratio (OR), 3.7; 95% confidence interval (CI), 1.8-7.8] and overlap of functional dyspepsia (OR, 35.4; 95% CI, 14.9-84.3) were predictors of symptomatic EE compared with asymptomatic EE. Symptomatic EE was more strongly associated with male sex (OR, 7.8; 95% CI, 2.9-20.9) than was NERD. Conclusion: Somatization was the most important determinant of GERD symptoms. Silent EE was prevalent among participants with GERD, even though its natural history and clinical significance are unknown.
Article
Background Little is known about possible underlying psychological abnormalities and physiology of reflux hypersensitivity (RH) as defined in the recent Rome IV classification. We aimed to assess markers of psychological comorbidity as well as gastro-esophageal reflux measurements in RH patients compared to controls and also in patients with functional heartburn (FH) and non-erosive reflux disease (NERD) versus controls. Methods Data of 304 patients visiting our Functional Diagnostics Centre from 2016 to 2018 were analyzed. We focused on a psychological assessment using validated questionnaires (visceral sensitivity index; VSI, hospital anxiety and depression score; HADS) as well as multichannel intraluminal impedance (MII) and pH-metry data from the diagnostic work-up. Key Results We found a decreased VSI of 57.8 ± 15.4 points (pts) among RH patients (n = 45) indicating higher visceral sensitivity compared to 85.7 ± 2.0 pts in the control group (n = 31, P < 0.001). Furthermore, a significant difference in VSI was found between the FH (60.8 ± 23.3 pts, n = 59, P < 0.001) and between the NERD (61.9 ± 20.8 pts, n = 67, P < 0.001) both compared to the control group. The HADS also displayed a significant difference between the RH (11.9 ± 6.0 pts, P < 0.001), FH (11.0 ± 7.4 pts, P < 0.001), respectively, NERD (11.3 ± 8.9 pts, P < 0.001) as compared to the control group (2.0 ± 1.4 pts). Conclusions and Inferences Increased sensation to visceral stimuli as well as anxiety and depression appears to play an important role not only in reflux hypersensitivity and functional heartburn as defined by Rome IV but also in NERD. These findings are in line with the disease concept of disorders of gut-brain interaction in which psychological comorbidities and visceral hypersensitivity play a major role.
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A survey was conducted to examine the strength of a relationship that develops over the years between children (confined to teenagers and those below 24 years of age) and parents who stay together with their children as well as those who don’t. Also it was observed whether the distancing of children from the places they grew up and spent their childhood in after a particular age helped them become either independent or less dependent on their parents thus, helping them develop a more mature mentality than those staying with their parents. The survey was carried out in VIT University, Vellore, India selecting 60 day scholars (equivalent number of boys and girls) and 60 hostellers (equivalent number of boys and girls). Category specific sets of questionnaires were provided and the result was interpreted on the basis of the distance between parents and children and the decision making ability of an individual which directly affected the independency or dependency level of the child on his or her parents. The independent variable chosen here is distance between parent and children whereas the dependent variable taken is the independency in decision making ability observed in children.
Article
Psychological factors have been claimed to play a role in the predisposition for laryngopharyngeal reflux (LPR) symptoms. The aims of this work were to study the relationship between psychological disorders and LPR and to investigate the effect of potential psychological disorders on patients' self-perception of reflux-related problems. Forty-two patients with symptoms suggestive of LPR were psychologically evaluated using the Social Readjustment Rating Scale, the Symptom Checklist-90 Revised, the Manifest Anxiety Scale of Taylor, the Minnesota Multiphasic Personality Inventory, and the Zung Self-Rating Depression Scale. Oropharyngeal 24-hour pH monitoring was used to diagnose LPR. LPR-related symptoms were assessed using the reflux symptom index (RSI) and the voice handicap index-10 (VHI-10). Patients were divided into groups based on psychiatric evaluation and pH results. Correlations between psychological profile characteristics and LPR-related parameters were also investigated. No significant difference was found between the positive and negative LPR group for any of the assessed psychological disorders. Also, no significant difference was detected between the positive and negative psychological disorder groups regarding RSI, VHI-10, and pH results. Correlations between psychological profile parameters and LPR-related measures were also nonsignificant. It appears that there is no association between psychological disorders and LPR. The psychological background of the LPR patients had no influence on patients' self-perception of their reflux-related problems. © 2015 S. Karger AG, Basel.
Article
目的: 食道の知覚過敏はNERD (non-erosive reflux disease) 発症に重要な役割を果たしている. NERDの発生において食道知覚過敏がどのように関与しているかあまり検討されておらず, その発生頻度は地域や人種により異なるとされていることから, 日本人における食道の知覚過敏について検討を行った. 対象と方法: GERD (gastroesophageal reflux disease) 123人 (NERD: 60人, e-GERD (erosive gastroesophgeal reflux disease) : 53人, バレット食道: 10人) とコントロール: 26人を対象に酸食道感受性試験と胃内視鏡検査を行った. 酸に対する反応を症状持続時間, 症状の強さ, 感受性指数: SI (Sensitivity Index) の3つのパラメーターを用いて比較検討を行った. また制酸剤投与後の追跡調査をNERD: 16人, e-GERD: 11人を対象に比較検討を行った. 結果: 酸食道感受性試験では, NERDの“症状持続時間”,“症状の強さ”とSIの平均値は, e-GERDとバレット食道よりも高く, コントロールに比べて有意に高かった. 制酸剤投与後の追跡調査では, SI: 20以下の場合, NERDは様々な反応 (増悪: 71.4%, 改善: 28.6%) が認められるのに対し, SI: 21以上の場合は改善する傾向にあった (増悪: 11.1%, 不変: 33.3%, 改善: 55.6%). 結語: 日本人におけるNERDはe-GERD, バレット食道, コントロールより有意に食道知覚が過敏であり, NERDにおいて知覚過敏陽性群は酸分泌抑制剤が効果的であるが, 知覚過敏性群は酸分泌抑制剤投与にもかかわらず症状は悪化しており, 酸以外の要因の関与も示唆された. また, 酸食道感受性試験はNERDの予後の予測因子および治療方針の決定に有用であると思われた.
Article
Aim: The center for epidemiologic studies-depression scale (CES-D) and the frequency scale for symptoms of gastroesophageal reflux disease (the F-Scale) have been used as instruments to screen individuals with depression or gastroesophageal reflux disease (GERD). The aim of the present retrospective study was to investigate the relationship between psychiatric disorders, depressive symptoms, and reflux symptoms among outpatients. Methods: Data were collected from outpatients at our hospital. Of these outpatients, 861 completed both the F-Scale and the CES-D. The distribution of diagnoses was examined, a factor analysis of the F-Scale performed, and potential correlations between the CES-D and F-Scale, including the mean F-Scale subscales, investigated. Results: The analysis of the F-Scale yielded 2 factors: a general factor of gastric symptoms and heartburn, and a factor of reflux syndrome, which includes swallowing disorders and laryngeal symptoms. A high correlation between the CES-D and the F-Scale scores was found among patients with mild depressive episodes, moderate depressive episodes, adjustment disorder, panic disorder, schizophrenia, somatoform disorder, or other. In contrast, the correlation among patients with severe depressive episodes was lower than expected. Patients with eating disorders were found to have a high score on both subscales of the F-Scale. Conclusion: In this study, reflux symptoms were shown to be common among patients with psychiatric disorders. The results of this study emphasize the need to pay close attention to the digestive symptoms of patients with psychiatric disorders to promote the early identification and treatment of gastrointestinal disorders such as GERD.
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Background and purpose: Gastroesophageal reflux is the most common disease of the digestive tract which could have adverse effects on mental health and quality of life. Unfortunately, there is an increasing incidence of this disease in Iran. In this study we examined the relationship between mental health and quality of life in people with acid reflux disease in general population in Amol, 2012. Materials and methods: This cross sectional study included 473 people who were randomly selected via cluster sampling. Among the subjects 229 had gastroesophageal reflux disease while 224 people did not suffer from the disease. The questionnaires for demographic characteristics, mental health and quality of life and reflux were completed. To analyze the data t test, chi-square and Spearman correlation were applied. Results: Patients with reflux had lower scores in mental health status. Also, eight domains of quality of life in people with gastroesophageal reflux disease was lower for the domains of physical role, body pain, general health perception, vitality, social functioning, and mental health. Conclusion: In this study we found that mental health in people with gastroesophageal reflux is lower than that of the normal subjects. Also, the quality of life in these people, especially in six domains of physical role, body pain, general health perception, vitality, social functioning and mental health, was lower than those of the healthy people. © 2015 Mazandaran University of Medical Sciences. All rights reserved.
Article
Background: Little is known about the direction of causality among asthma, posttraumatic stress disorder (PTSD), and onset of gastroesophageal reflux symptoms (GERS) after exposure to the 9/11/2001 World Trade Center (WTC) disaster. Methods: Using data from the WTC Health Registry, we investigated the effects of early diagnosed post-9/11 asthma and PTSD on the late onset and persistence of GERS using log-binomial regression, and examined whether PTSD mediated the asthma-GERS association using structural equation modeling. Results: Of 29,406 enrollees, 23% reported GERS at follow-up in 2011-2012. Early post-9/11 asthma and PTSD were each independently associated with both the persistence of GERS that was present at baseline and the development of GERS in persons without a prior history. PTSD mediated the association between early post-9/11 asthma and late-onset GERS. Conclusions: Clinicians should assess patients with post-9/11 GERS for comorbid asthma and PTSD, and plan medical care for these conditions in an integrated fashion. Am. J. Ind. Med. 59:805-814, 2016. © 2016 Wiley Periodicals, Inc.
Article
Psychological factors are closely related to the pathogenesis of gastroesophageal reflux disease, irritable bowel syndrome, functional dyspepsia, and other gastrointestinal diseases. It has been widely accepted that psychological factors play a very important role in refractory gastroesophageal reflux disease (RGERD). This article reviews the role of psychological factors in the epidemiology, pathogenesis, assessment, and management of RGERD.
Chapter
The transformation of the health care systems from Health 1.0 to 4.0 will bring fundamental changes to the health care sector. Virtualization of health care will improve the delivery of care through patient empowerment, but patients cannot be empowered if they do not have the required capacity (i.e. knowledge, abilities and supporting mechanisms). To achieve virtualization of health care, it is necessary to build capacity. Capacity building is “means by which skills, experience, technical and management capacity are developed within an organisational structure (contractors, consultants or contracting agencies)—often through the provision of technical assistance, short/long-term training, and specialist inputs (e.g., computer systems). The process may involve the development of human, material and financial resources” [1]. Capacity building, on the one hand, can be a means to develop a set of relevant capacities to adopt new virtualised health care technologies in order to improve health outcomes. On the other hand, virtualization of health care can enable capacity building. Digital health care technologies can be used to build up the capacity of patients by increasing their knowledge and skills and help them become active partners in their own health care. In order to entice users to adopt the new health care technology, it is important to address and fulfil their psychological, cultural and interpersonal needs. Psychological models can be used to influence the design and development of health care technologies for Health 4.0 which in turn serve to encourage acceptance and uptake the new digital health care technologies, support individuals in reaching engaging experiences with the new technologies, promoting behavioral change and improving health outcomes.
Chapter
To review what we have covered so far, Chap. 2 proposed a model of how psychosocial factors can activate myriad neurological, neuroendocrine, and endocrine response axes. Similarly, Chap. 2 reviewed the physiological constituents of these stress axes in considerable detail. Chapter 5 reviewed the link from stress arousal to disease by summarizing several noteworthy models constructed to elucidate how stress arousal can lead to disease and dysfunction, that is, mechanisms of pathogenesis that link causally stress arousal to target-organ pathology. The goal of this chapter is to review some of the most common clinical manifestations of excessive stress and, more specifically, to familiarize the reader with some of the most frequently encountered target-organ disorders believed to be related to excessive stress arousal.
Article
OBJECTIVE The aim of the study was to investigate the relationship between Gastro-esophageal reflux diseases (GERD) related symptoms and psychological symptomatology, as well as clinically diagnosed generalized anxiety disorder (GAD) or panic disorder (PD) and effectiveness of Sertraline and benzodiazepines in controlling these conditions. METHODOLOGY A 6 months prospective study was conducted in gastroenterology outpatient department of a tertiary care referral hospital. Refractory GERD was diagnosed by assessing proton pump inhibitor failure over 4 week trial of standard doses of PPIs. Therapy with Benzodiazepines and Sertraline was initiated in patients with refractory GERD having panic and anxiety symptoms associated with refractory GERD. Effectiveness of the therapy was measured using panic and agoraphobia scale and Hamilton anxiety scale. Reduction in the severity of GERD symptoms was assessed using GERD – Health related quality of life scale. RESULTS The occurrence of PD or GAD in patients with refractory GERD in our sample was found to be 68% and 32% respectively. There was a significant decrease in the score of GERD HRQOL after the administration of sertraline and benzodiazepines when compared to the score of GERD HRQOL before administration of interventional drugs (p=0.001). CONCLUSION Our study investigated the role of anxiety and panic in refractory GERD and their effect on quality of life. The results indicated that quality of life of patients were highly improved as indicated by severity scores after administration with sertraline and benzodiazepines. The novel therapy of sertraline and benzodiazepines are highly effective in controlling reflux like symptoms and coexisting anxiety and panic disorder in refractory GERD.
Article
Gastroesophageal reflux disease (GERD) has been related with certain psychological dimensions. The influence of mood, emotional intelligence, and perceived quality of life on clinical symptoms and outcome of antireflux surgery was evaluated in GERD patients with and without hiatal hernia. The study included 61 patients who were diagnosed with GERD between 2003 and 2008: 16 of them without hiatal hernia (group A) and 45 of them with hiatal hernia (group B). All of these patients had undergone laparoscopic antireflux surgery. Patients were clinically examined and evaluated with the following instruments: Short Form (SF)-36 Health Survey, Gastrointestinal Quality of Life Index, Hospital Anxiety and Depression (HAD) Scale, and Trait Meta-Mood Scale (TMMS)-24. Proportions were compared by using the chi-squared test; averages were compared by using the Student's t-test (with Bonferroni's correction). In general, our patients intervened for GERD showed results lower than normal or close to the lower limit of normal in the administered tests. Patients in the group without hernia were younger (P < 0.001) and with lower American Society of Anaesthesiologists risk. They showed higher scores in the SF-36 dimensions: Physical Functioning, Physical Role and Emotional Role, and lower scores in the Social Role (P < 0.001). They showed lower scores in the Emotional dimension of Gastrointestinal Quality of Life Index (P = 0.0068) and worse results in the Hospital Anxiety and Depression subscales of Anxiety (P < 0.001) and Depression (not significant). Men in the group without hernia showed higher scores than men in the group with hernia in the TMMS subscales corresponding to Emotional Clarity and Emotional Repair (P < 0.001). Women in the group with hernia showed higher scores than women in the group without hernia regarding Emotional Clarity (P = 0.0012). GERD patients showed poor results in all the tests, and patients without hiatal hernia compared with patients with hernia showed higher levels of anxiety, which interfered with their social life. Moreover, they showed lower tolerance to stress and higher frustration, fear, and worry. On the basis of such unfavorable phychoemotional results observed with GERD patients (especially those without hernia) in the different tests, we propose that improving our knowledge of the psychological profile of GERD patients - particularly those without hiatal hernia - could help in designing individualized medical and psychological therapies and increase success rates.
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A 25-year-old woman with a 12-year history of panic disorder with agoraphobia and gastrointestinal symptoms was treated using a cognitive-behavioral program which included: (a) correcting misconceptions about normal bowel functioning, (b) graduated in vivo exposure to internal stimuli which she misinterpreted as precursors of loss of bowel control, (c) graduated in vivo exposure to external stimuli associated with fears of loss of bowel control, (d) establishment of regular eating patterns, and (e) bowel control training. Self-ratings of avoidance and distress, frequency of panic attacks, diazepam use, and negative cognitions decreased with treatment. Treatment gains were maintained at 18-month follow-up. Tailoring of cognitive-behavioral treatment to panic with fears of loss of bowel control was emphasized.
Article
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The functional esophageal disorders include globus, rumination syndrome, and symptoms that typify esophageal diseases (chest pain, heartburn, and dysphagia). Factors responsible for symptom production are poorly understood. The criteria for diagnosis rest not only on compatible symptoms but also on exclusion of structural and metabolic disorders that might mimic the functional disorders. Additionally, a functional diagnosis is precluded by the presence of a pathology-based motor disorder or pathological reflux, defined by evidence of reflux esophagitis or abnormal acid exposure time during ambulatory esophageal pH monitoring. Management is largely empirical, although efficacy of psychopharmacological agents and psychological or behavioral approaches has been established for several of the functional esophageal disorders. As gastroesophageal reflux disease overlaps in presentation with most of these disorders and because symptoms are at least partially provoked by acid reflux events in many patients, antireflux therapy also plays an important role both in diagnosis and management. Further understanding of the fundamental mechanisms responsible for symptoms is a priority for future research efforts, as is the consideration of treatment outcome in a broader sense than reduction in esophageal symptoms alone. Likewise, the value of inclusive rather than restrictive diagnostic criteria that encompass other gastrointestinal and non-gastrointestinal symptoms should be examined to improve the accuracy of symptom-based criteria and reduce the dependence on objective testing.
Article
Background: Psychological aspects such as stress, emotions, illness behaviour or personality are known to affect the severity of symptoms of gastroesophageal reflux disease (GERD) and can influence medical outcome in some patients. The aim of the present study was to evaluate the efficacy of psychological intervention within routine surgical care on the surgical outcome of laparoscopic antireflux surgery (LARS) in patients with stress-ralated GERD symptoms during a 1-year follow-up. Methods: Out of a sample of 196 consecutive patients who required LARS (Nissen fundoplication), a group of 89 (45%) believed that stress was a factor in the cause of their symptoms (stress-related versus stress-unrelated GERD patients). Patients with stress-related symptoms were randomly assigned to the psychological intervention (PI group; n = 42) or control group with routine surgical care (RC group; n = 42). Five patients were excluded from the study. Assessments of surgical outcome were: objective clinical data such as DeM...
Article
Background: Psychological aspects like stress, emotions or personality are known to affect the severity of symptoms of gastroesophageal reflux disease (GERD). The aim of the present study was to evaluate differences in coping with stress, structure of personality and also objective and subjective parameters of patients with or without a stress-related perception of symptoms in GERD. Methods: 100 patients which underwent laparoscopic antireflux surgery at our department of surgery were included in this study. All patients answered questionnaires to evaluate their coping with stress (SVF), structure of personality (FPI-R) and quality of life (GILQI) pre- and postoperatively. Also data of physiological parameters like manometry, 24-hours pH monitoring, endoscopy and clinical history were included. Patients were divided into two groups: one with and one without a stress-related perception of symptoms. Results: 46 out of 100 patients declared stress-related symptoms of reflux (group 1) and 54 out of 100 had no influence of stress to their reflux disease (group two). Those two groups showed significant differences (p < .05) in some coping strategies and their personality: Coping with stress (SVF): Trial to control the situations (18.3 vs. 13.1), trial to control reactions (18.2 vs. 13.3), requirement of social support (9.7 vs. 14.8), tendency to escape (7.7 vs. 13.9) and aggression (13.1 vs. 7.6): structure of personality (FPI-R): Standard of performance (10.8 vs. 7.2), stress (9.8 vs. 4.7) and physical discomfort (7.6 vs. 4.6). We also found significant (p < .05) differences in pre-and postoperative quality of life (GILQI: preoperative 86.3 vs. 98.5 points; postoperative 117.9 vs. 128.2 points) and the day-time of reflux perception. There were no differences in physiological parameters. Conclusion: These findings point out that there are no physiological differences between the two groups with or without stress-related symptoms in GERD. But we found significant differences in psychological factors. Therefore we suggest that preoperative psychological interventions may optimize the subjective outcome after antireflux surgery in patients with a stress-related perception of symptoms.
Article
The relationship between various stressful stimulus conditions, measures of anxiety, and altered esophageal motility was investigated in mo experiments employing normal adult volunteers. In Experiment 1, subjects were administered separately I00dB continuous white noise and a cold pressor task. In Experiment 2. subjects were administered in a counterbalanced order intermittent and unpredictable bursts of 100dB white noise and a cognitive task consisting of solvable and unsolvable discrimination problems. Results of both experiments showed that the amplitudes of peristaltic esophageal contractions and levels of state anxiety self-reports were significantly higher during periods of stress than during preceding baseline periods. Furthermore, in Experiment 2, esophageal contraction velocities and anxiety-related behaviors were significantly greater during stress periods than during baselines. Contrary' to previous studies, few abnormal tertiary esophageal contractions were elicited by stress. The present results identify increased amplitude of the peristaltic contractions as the primary esophageal response to stress. Technological and methodological differences between this study and previous Investigations of affective disturbance among patients with chronic esophageal chest pain also are examined.
Article
Patients with gastroesophageal reflux disease (GERD) experience a wide spectrum of symptoms, varying both in quality and severity. This review summarizes clinical observations of esophageal sensitivity and symptom perception in GERD patients. The Bernstein test, although lacking standardization, remains a useful tool in determining esophageal sensitivity to acid stimuli. Ambulatory 24-hour pH monitoring with symptom event marking and subsequent symptom-reflux correlation between acid reflux events and esophageal symptomatology now provides an alternative method for establishing esophageal acid sensitivity. The intraesophageal balloon distention test (IEBD) was developed to assess esophageal sensitivity to mechanical stimuli. Variants of each of these tests have been applied to the evaluation of uncomplicated GERD patients and patients with esophagitis and Barrett’s metaplasia, who generally demonstrate less esophageal sensitivity than the former group. Studies using these methods have demonstrated increased esophageal sensitivity in patients with esophageal chest pain and have also identified a subset of patients with esophageal symptoms yet normal esophageal acid exposure, a condition referred to as "hypersensitive esophagus." The Bernstein test, 24-hour pH monitoring with symptom assessment, and IEBD have each ontributed to our understanding of esophageal pain syndromes; it is hoped that future work in this area will lead to improved and more specific therapy for these patients.
Article
Background: For the evaluation of surgical interventions, quality of life data are being increasingly used as an efficacy endpoint. Aims: To evaluate impact of laparoscopic fundoplication and laparoscopic refundoplication on quality of life as well as on patient satisfaction with the procedure for at least 5 years after surgical intervention. Patients: After more than 500 laparoscopic antireflux procedures, quality of life data have been prospectively reviewed and data compared with healthy individuals, untreated gastro-oesophageal reflux disease patients (n = 150) and successfully treated patients (n = B4) under adequate omeprazole therapy. Methods: Gastrointestinal Quality of Life Index has been used in all patients and evaluated the day before surgery and 5 times after surgery. Moreover, the SF-36 questionnaire has been used up to 2 years after surgical intervention, but only in patients who underwent laparoscopic redo-surgery (n = 49). Results: In both surgical groups, mean preoperative Gastrointestinal Quality of Life Index showed a significant (p < 0.01) impairment (before laparoscopic antireflux surgery: 90.4 +/- 10.3 points; before redo-surgery: 84.3 +/- 8.1 points) when compared with healthy individuals (mean: 122.6 +/- 8.5 points) and successfully treated patients with acid-suppressive therapy (mean: 121.4 +/- 9.2 points). After surgery, the mean Gastrointestinal Quality of Life Index increased significantly and remained stable for at least 5 years after laparoscopic antireflux surgery (120.8 +/- 8.6 points) or for at least 2 years after redo-proce-dure (120.9 +/- 7.2 points). Before laparoscopic refundoplication, 6 out of 8 SF-36 scores were significantly p < 0.05) decreased. Redo-surgery influenced these 6 scores significantly (p < 0.05-0.01), resulting in values comparable to those of general population. Patients' satisfaction with surgery was excellent or good in 95%. Conclusion: Both, laparoscopic fundoplication as well as laparoscopic refundoplication are able to improve patients' quality of life significantly for at least 5 years. Therefore, quality of life data provide useful information to discuss different treatment options with patients.
Article
The effect of cold stress on postprandial lower esophageal sphincter competence and gastroesophageal reflux was investigated in nine healthy subjects. All subjects were studied twice in a randomized order according to a common protocol: 30 min after completion of a 700-kcal meal they put their nondominant hand in water either at 37 degrees C (control stimulus) or at 4 degrees C (stressful stimulus) cyclically for 20 min. Pulse rate and blood pressure rose significantly (P less than 0.01) during the stressful stimulus, but remained unaffected by the control stimulus. Rate of transient lower esophageal sphincter relaxations/30 min [median (interquartile range)] was similar before and during control stimulus, 4 (2.7-5.0) and 3 (2.0-4.5), respectively, whereas it was markedly inhibited during the stressful stimulus [from 5 (3.7-6.0) to 2 (1.0-2.0); P less than 0.05 vs control stimulus]. Rate of reflux episodes/30 min was also similar before and during control stimulus, 1 (0-1.2) and 1 (1.0-2.2), but fell consistently during the stressful stimulus [from 2 (0-3.2) to 1 (0-2.0); P less than 0.05 vs control stimulus]. Percentage of transient lower esophageal sphincter relaxations accompanied by a reflux episode was unaffected by stress as was basal lower esophageal sphincter pressure. It is concluded that cold stress decreases the postprandial rate of transient lower esophageal sphincter relaxations and reflux episodes in healthy humans.
Article
The purpose of this investigation is to determine if the high prevalence rates of major depression, panic disorder, and agoraphobia found in tertiary-care studies of irritable bowel syndrome and medically unexplained gastrointestinal symptoms are also found in the general population. Structured psychiatric interviews on 18,571 subjects from the NIMH Epidemiologic Catchment Area (ECA) Study were reviewed for prevalence of gastrointestinal distress symptoms and selected psychiatric disorders. Medically unexplained gastrointestinal symptoms had a high prevalence in the general population (6-25%). When compared with those reporting no gastrointestinal symptoms, subjects who report at least one of these symptoms were significantly more likely to have also experienced lifetime episodes of major depression (7.5% vs 2.9%), panic disorder (2.5% vs 0.7%), or agoraphobia (10.0% vs 3.6%). Subjects with two gastrointestinal symptoms had even higher lifetime rates of depression (13.4%), panic (5.2%), or agoraphobia (17.8%). Lifetime rates of affective and anxiety disorders in the general population are higher in subjects with gastrointestinal symptoms compared with subjects without gastrointestinal symptoms. An even higher prevalence of affective and anxiety disorders is found in patients with medically unexplained gastrointestinal symptoms in tertiary-care clinics. Future studies are needed in primary-care populations where prevalence rates of psychiatric illness are probably intermediate between those of the general population and tertiary care.
Article
It is imperative to assess the psychosocial factors that may influence the subjective experiences and pain behavior of persons with chronic unexplained chest pain. Both psychologists and physicians tend to rely on self-report measures of psychological distress, which provide little unique information about patients with chronic chest pain to differentiate them from patients with other painful disorders such as irritable bowel syndrome, gastroesophageal reflux disease, or coronary artery disease. However, assessment of pain-coping strategies, spouse responses to the patient's pain behaviors, and pain thresholds for esophageal balloon distention do differentiate patients with chronic chest pain from healthy controls and patients with various other chronic pain disorders. Specifically, chronic chest pain patients tend to use relatively passive pain-coping strategies such as praying and hoping, and to report relatively high levels of spouse reinforcement of pain behaviors. Finally, in response to esophageal balloon distention, chronic chest pain patients display low pain thresholds that do not generalize to stimulation by mechanical finger pressure. Preliminary evidence suggests these low thresholds are due primarily to a tendency to set low standards for making pain judgments regarding esophageal stimuli of moderate-to-high intensity levels.
Article
In 17 patients with esophagitis (degree I = erythema, N = 10; degree II = erosions, N = 7) esophageal pH was measured at 5 and 10 cm above the esophagogastric junction to assess whether the extension of acid reflux and the severity of the mucosal lesions could influence the association between reflux and symptoms. A minority of the refluxes were related with symptoms (4.0% and 7.7% in degree I, 14.1% and 12.0% in degree II at 5 and 10 cm respectively), whereas 65.4% and 100% of the symptoms were related with reflux in degrees I and II, respectively, with 76.5% and 35.7% occurring during refluxes reaching the proximal recording site. A relationship of symptoms with reflux is shown, particularly in erosive disease. Some reflux characteristics (extension, duration, acidity) seem to influence symptom occurrence mainly in mild esophagitis; however, more than 85% of the acid reflux episodes are symptom-free, regardless of the severity of the mucosal injury.
Article
The ability of hypnosis to both stimulate and inhibit gastric acid secretion in highly hypnotizable healthy volunteers was examined in two studies. In the first, after basal acid secretion was measured, subjects were hypnotized and instructed to imagine all aspects of eating a series of delicious meals. Acid output rose from a basal mean of 3.60 +/- 0.48 to a mean of 6.80 +/- 0.02 mmol H+/h with hypnosis, an increase of 89% (p = 0.0007). In a second study, subjects underwent two sessions of gastric analysis in random order, once with no hypnosis and once under a hypnotic instruction to experience deep relaxation and remove their thoughts from hunger. When compared to the no-hypnosis session, with hypnosis there was a 39% reduction in basal acid output (4.29 +/- 0.93 vs. 2.60 +/- 0.44 mmol H+/h, p less than 0.05) and an 11% reduction in pentagastrin-stimulated peak acid output (28.69 +/- 2.34 vs. 25.43 +/- 2.98 mmol H+/h, p less than 0.05). We have shown that different cognitive states induced by hypnosis can promote or inhibit gastric acid production, processes clearly controlled by the central nervous system. Hypnosis offers promise as a safe and simple method for studying the mechanisms of such central control.
Article
The present study was designed to explore the relationship between psychological stress and esophageal motility disorders. Nineteen non-cardiac chest pain patients (10 with the nutcracker esophagus and nine with normal baseline manometry) and 20 healthy control subjects were administered two acute stressors: intermittent bursts of white noise and difficult cognitive problems. The results indicated that the esophageal contraction amplitudes and levels of anxiety-related behaviors of non-cardiac chest pain patients and control subjects were significantly greater during the stressors than during baseline periods. All patients demonstrated significantly greater (P less than 0.01) increases in contraction amplitude and anxiety-related behavior during cognitive problems than during the noise stressor. The nutcracker esophagus patients showed a greater increase in contraction amplitude during the problems (23.50 +/- 9.42 mm Hg, X +/- SE) than control subjects (P less than 0.01), while the amplitude changes of chest pain patients with normal baseline manometry were not significantly greater than that of control subjects (9.00 +/- 1.91 mm Hg). The present results identified an increase in contraction amplitude as the primary esophageal response to stress. The possible interaction of esophageal contraction abnormalities, psychological stress, and the perception of chest pain is discussed.
Article
A 31-year-old man with a 19-year history of rumination developed frequent episodes of heartburn and regurgitation associated with acid gastroesophageal reflux that occurred predominantly during the day. This reflux and its attendant symptoms resulted from abdominal muscle contractions at the time of gastroesophageal pressure equilibration (i.e., common cavity phenomena) consistent with the egress of air from the stomach to the esophagus. A voluntary pharyngeal maneuver unassociated with swallowing but simultaneous with the abdominal contraction resulted in a decrease in upper esophageal sphincter pressure. This lowered pressure facilitated acid esophagopharyngeal regurgitation at a velocity of 100 cm/s. Biofeedback therapy directed at relaxing the abdominal muscles during eating and avoiding the pharyngeal maneuver resulted in a decrease in reflux and marked improvement in symptoms.
Article
During a course of 10 biofeedback sessions in a single subject, the lower esophageal sphincter pressure measured with an open-tipped perfused catheter assembly showed significant and progressive increase with each session, until it reached normal levels. There was also a decrease in symptomatic reflux episodes, from three times daily to once every 2 weeks. Macroscopic esophagitis was detected by endoscopy before the first session, but was no longer evident in the endoscopic examination after biofeedback training. After the biofeedback training program, the subject was able to control his lower esophageal sphincter without biofeedback.
Article
To evaluate gastroesophageal reflux disease in the elderly (people > or = 60 yr). Basal gastric acid secretion was prospectively determined in 228 consecutive patients with symptomatic gastroesophageal reflux disease who had upper gastrointestinal endoscopy and were diagnosed with either pyrosis alone (n = 98), erosive esophagitis (n = 87), or Barrett's esophagus (n = 43). Patients > or = 60 yr (n = 66) had significantly more esophageal mucosal disease (erosive esophagitis, Barrett's esophagus) than patients < 60 yr (n = 162)--81% versus 47% (p = 0.000002, Fisher's exact test). Furthermore, 87% of patients > or = 70 yr had esophageal mucosal disease. For each decade from < 30 yr to > or = 70 yr, there was a significant increase in esophageal mucosal disease (p = 0.002; chi 2 test, 23.96); however, there were no significant differences in severity of pyrosis symptoms or in mean basal acid output for each decade. When 146 of the 228 patients with gastroesophageal reflux disease were given enough ranitidine (mean, 630 mg/d; range, 300-3000 mg/d) for the relief of all pyrosis symptoms and healing of all esophageal mucosal disease, there were no significant differences in ranitidine therapy between each decade. Elderly patients with pyrosis symptoms severe enough to require upper gastrointestinal endoscopy have gastroesophageal reflux disease with more esophageal mucosal disease (erosive esophagitis, Barrett's esophagus) than patients < 60 yr, and like younger patients, may require markedly increased doses of ranitidine as large as 2400 mg/d for effective therapy.
Article
Previous studies have shown that psychological factors play a role in symptom perception among patients with gastroesophageal reflux disease. This report describes the first controlled study showing the effects of relaxation training on symptom reports and esophageal acid exposure in patients with reflux disease. Twenty subjects with documented reflux disease were studied during psychologically neutral and stressful tasks, followed immediately by either a relaxation or attention-placebo control intervention. Stressful tasks, relative to neutral tasks, produced significant increases in blood pressure, subjective ratings of anxiety, and reports of reflux symptoms. Despite increased symptom reports, stressful tasks did not significantly increase objective measures of esophageal acid exposure. Subjects who received a relaxation intervention after the stressful task had significantly lower heart rate values and subjective ratings of anxiety compared with subjects who received the attention-placebo control intervention. Subjects who received relaxation training also had significantly lower reflux symptom ratings and total esophageal acid exposure than subjects who received the attention-placebo control intervention. Relaxation may be a useful adjunct to traditional antireflux therapy in patients who experience increased symptoms during stress.
Article
This paper describes the first controlled study of the relationships among stress, psychological traits associated with chronic anxiety, acid reflux parameters, and perceptions of reflux symptoms. Seventeen subjects with symptomatic reflux disease were studied using a 2 (high vs. low gastrointestinal susceptibility score) x 2 (stress vs. neutral tasks) x 3 (periods 1, 2, or 3) experimental design. It was found that the stress tasks produced significant increases in systolic and diastolic blood pressure, pulse rates, and subjective ratings of anxiety and reflux symptoms. The stress tasks, however, did not influence objective parameters of acid reflux (total acid exposure, number of reflux episodes, duration of longest reflux episode). Moreover, the effect of stress on reflux ratings was due primarily to the responses of the subjects with high gastrointestinal susceptibility scale scores. These subjects' reflux ratings remained at high levels during all stress periods, whereas subjects in all other experimental conditions reported decreased reflux symptoms across periods. These results suggest that reflux patients who are chronically anxious and exposed to prolonged stress may perceive low intensity esophageal stimuli as painful reflux symptoms. Future effort should be devoted to examining the efficacy of anxiolytic and behavioral therapies with these reflux patients.
Article
While gastroesophageal reflux is amenable to medical and surgical treatment, the severity of pathophysiologic changes of the disease correlates poorly with the symptomatology. Similarly, the overall successful outcome of surgical therapy can be lessened by the poor outcome in a small number of patients despite the technical success of the operation. We conducted a study to determine the influence of illness behavior on the outcome and efficacy of laparoscopic Nissen fundoplication. From a larger group of patients undergoing a laparoscopic Nissen fundoplication, 77 patients (57 male, 20 female) completed an illness behavior questionnaire before and after surgery. This previously validated questionnaire assessed 10 scales of illness behavior. The results were compared with visual analog scales of outcome for overall satisfaction, heartburn, and solid food dysphagia, which were elicited independently from a standardized clinical follow-up questionnaire. Patients completed the questionnaire on average 2 months before and 25 months after surgery. High preoperative and postoperative scores for the "affective" and "hypochondriacal" scales were associated with poorer satisfaction with the surgical outcome. Although successful relief of reflux symptoms was unrelated to any preoperative illness behavior scale, postoperative scores for "disease conviction" and "disease affirmation" were predictors of further symptomatic heartburn in a small group of patients. Dysphagia did not correlate with illness behavior. When preoperative and postoperative scores were compared, no change in illness behavior was demonstrated, with the exception of lower scores for disease conviction and disease affirmation. These results suggest that while patient perception of disease is improved by laparoscopic fundoplication, patient satisfaction with the surgical outcome is in part determined by preoperative illness behavior.
Article
The Gastroesophageal Reflux Disease-Health-Related Quality of Life (GERD-HRQL) scale is a reliable, valid, responsive, and practical measure of symptom severity in patients with GERD. This type of scale is needed to determine effects of treatments and their comparison. This study defines the relationship between the GERD-HRQL score and the physiologic parameters of esophagogastroduodenoscopy, esophageal manometry, and 24-hour esophageal pH monitoring. Fifty-five patients referred for surgical evaluation of GERD answered the GERD-HRQL, a nine-item ordinal-scaled questionnaire. They were evaluated with esophagogastroduodenoscopy, esophageal manometry, and 24-hour pH monitoring. The relationships among these results were determined by linear regression analysis. There were no correlations between lower esophageal sphincter (LES) and any of the pH monitoring parameters (all r < 0.25, P > 0.2), esophagitis grade (r = -0.21, P = 0.2), nor any individual GERD-HRQL item score nor total score (all r < 0.2, P > 0.11). There were correlations between all the pH monitoring parameters and esophagitis grade (all r > 0.6, P < 0.001), but not with any of the GERD-HRQL item scores or total score (r < 0.3, P > 0.15). Six of the nine items scores and the total GERD-HRQL score correlated with esophagitis grade (all r > 0.4, P < 0.01). LES pressure is a poor indicator of symptom severity, the amount of reflux, and esophageal mucosal damage. pH monitoring-measured reflux and GERD-HRQL-measured symptom severity correlate well with mucosal damage. If the goals of GERD treatment are to relieve symptoms and reverse mucosal damage, the GERD-HRQL score and 24-hour pH monitoring are better outcome measures than the LES pressure. In an era of cost containment, the GERD-HRQL may be an adequate outcome measure.
Article
To determine if patients with gastroesophageal reflux "well controlled medically" had a different quality of life from those with residual symptoms receiving aggressive medical therapy, and to determine whether laparoscopic antireflux surgery significantly altered quality of life in patients with gastroesophageal reflux. Clinical determinants of outcome may not adequately reflect the full impact of therapy. The medical outcomes study short form (SF-36) is a well-validated questionnaire that assays eight specific health concepts in three general fields. It may provide a more sensitive tool for judging the success of antireflux therapy. A total of 345 patients undergoing laparoscopic antireflux surgery completed at least one questionnaire during the study period. Preoperative questionnaires were completed by 290 patients, 223 completed a questionnaire 6 weeks after surgery, and 50 completed the same questionnaire 1 year after surgery. A subgroup of 70 patients was divided before surgery into two groups on the basis of their response to standard medical therapy. Preoperative scores were extremely low. All eight SF-36 health categories improved significantly 6 weeks and 1 year after surgery. In the 70-patient subgroup, 53 patients (76%) underwent laparoscopic antireflux surgery because of symptoms refractory to medical therapy and 17 patients (24%) reported that their symptoms were well controlled but elected to have surgery because they wished to be medication-free. The preoperative quality of life scores of these two patient groups were equivalent in all but one category. Postoperative scores were significantly improved in all categories and indistinguishable between the two groups. Laparoscopic antireflux surgery is an effective therapy for patients with gastroesophageal reflux and may be more effective than medical therapy at improving quality of life.
Article
Psychological aspects like stress, emotions or personality are known to affect the severity of symptoms of gastroesophageal reflux disease (GERD). The aim of the present study was to evaluate differences in coping with stress, structure of personality and also objective and subjective parameters of patients with or without a stress-related perception of symptoms in GERD. 100 patients which underwent laparoscopic antireflux surgery at our department of surgery were included in this study. All patients answered questionnaires to evaluate their coping with stress (SVF), structure of personality (FPI-R) and quality of life (GILQI) pre- and postoperatively. Also data of physiological parameters like manometry, 24-hours pH monitoring, endoscopy and clinical history were included. Patients were divided into two groups: one with and one without a stress-related perception of symptoms. 46 out of 100 patients declared stress-related symptoms of reflux (group 1) and 54 out of 100 had no influence of stress to their reflux disease (group two). Those two groups showed significant differences (p < .05) in some coping strategies and their personality: Coping with stress (SVF): Trial to control the situations (18.3 vs. 13.1), trial to control reactions (18.2 vs. 13.3), requirement of social support (9.7 vs. 14.8), tendency to escape (7.7 vs. 13.9) and aggression (13.1 vs. 7.6); structure of personality (FPI-R): Standard of performance (10.8 vs. 7.2), stress (9.8 vs. 4.7) and physical discomfort (7.6 vs. 4.6). We also found significant (p < .05) differences in pre- and postoperative quality of life (GILQI: preoperative 86.3 vs. 98.5 points; postoperative 117.9 vs. 128.2 points) and the day-time of reflux perception. There were no differences in physiological parameters. These findings point out that there are no physiological differences between the two groups with or without stress-related symptoms in GERD. But we found significant differences in psychological factors. Therefore we suggest that preoperative psychological interventions may optimize the subjective outcome after antireflux surgery in patients with a stress-related perception of symptoms.
Article
A system of magnetic field goniometry was developed for measuring the frequency of stomach contractions. This technique uses a handheld, electronic compass to measure the angular change in direction of a magnetic field generated by a small, ingested magnet. Measurements of gastric mechanical activity made by goniometry were validated with simultaneous measurements using manometry and electrogastrography. The agreement between these different modalities was excellent. In this pilot study, magnetic field goniometry provided an easy, minimally invasive, and accurate method to measure the frequency of gastric contractions.
Article
Antidepressants are of demonstrated value in short-term treatment of functional chest pain, but long-term outcome data are unavailable. Follow-up information over a median of 2.7 years (0.8-8.6 years) was systematically obtained from 21 outpatients treated with tricyclic antidepressants after incomplete response to antireflux therapy. Initial treatment produced at least moderate symptom reduction or remission in 17 subjects (81.0%). Of these, 7 (41.2%) were successfully treated continuously or for symptom relapses over an average of 2.6 years; 5 (29.4%) discontinued successful treatment after >0.5 years with sustained benefits; and 5 (29.4%) eventually discontinued treatment because of side effects or for uncertain reasons (1 having a sustained remission). Low-dose tricyclic antidepressants were considered the most effective long-term chest pain treatment significantly more often than were antireflux medications or calcium-channel blockers in this selected patient group (P<0.05 for each). We conclude from this retrospective review that fully three fourths of subjects with functional chest pain who initially respond to open-label treatment with low-dose tricyclic antidepressants will use them continuously or for symptom relapses over at least the next two to three years and consider them the most effective treatment for their symptoms.
Article
Dysphagia is the most common complication of antireflux surgery. Temporary dysphagia occurs in addition to persistent dysphagia because of technical or physiological problems. Temporary dysphagia may be due to the patient's personal perception or faulty eating habits. The aim of this study was to investigate the impact of the patient's personality as it relates to temporary dysphagia and individual impairment. Several studies have used the construct of personality known as "health locus of control" to predict health-related behavior and convalescence after medical or surgical treatments. This study investigates the predictability of the subjective degree of dysphagia and its perceived degree of impairment in relation to the health locus of control after laparoscopic so-called "floppy" Nissen fundoplication in 90 patients. Several questionnaires and single-item questions were given to the patients preoperatively, and 1 wk, 6 wk, and 3 months after surgery. The answers to the questions provided the data for this study. Preoperatively, 92% of the patients had no dysphagia and 8% had a mild subjective degree of dysphagia. Temporary postoperative dysphagia was found in approximately 50% of the patients 1 wk after surgery. The intensity of the dysphagia ranged among mild (18%), moderate (15%), and severe (16%). Three months postoperatively about 80% had no dysphagia and only 2% severe dysphagia. Correlations between the construct of personality and the intensity of postoperative dysphagia and its impairment revealed a significant relationship at all times. Patients with high expectations for their own health-related abilities (internal control) had less dysphagia (r = -0.78 after 1 wk [p<0.001], r = -0.71 after 6 wk [p<0.001], and r = -0.64 after 3 months [p<0.001]), compared with patients who believed that their convalescence depended more on luck, chance, or fate (external control) (r = 0.67 after 1 wk [p<0.01], r = 0.72 after 6 wk [p<0.001], and r = 0.63 after 3 months [p<0.01]). These results are highly significant. The correlation between health locus of control the degree of a subjective impairment from perceived dysphagia showed similar results (p<0.01). The subjective degree of dysphagia and the perceived impairment as a result of laparoscopic antireflux surgery can be predicted according to the personality of the patient. Those patients with low expectations for their own abilities can be identified before surgery, thereby allowing adaptation techniques to be applied that could improve the results and well-being of patients after antireflux surgery.
Article
Most of the information used to determine a patient's candidacy for antireflux surgery has centered on physiologic measurements of esophageal functioning and quantitative assessment of acid reflux. Unfortunately, little attention has been paid to the study of psychosocial factors that could affect outcomes. The purpose of this study was to establish whether concomitant psychiatric disorders might affect the symptomatic outcomes of antireflux surgery. We retrospectively reviewed a prospectively gathered database of patients with gastroesophageal reflux disease (GERD) who underwent either open or laparoscopic antireflux surgery. A history of a psychiatric disorder was considered to be present if the patient had been previously diagnosed with a DSM-IV psychiatric diagnosis and was being medically treated for it. Preoperatively, patients were evaluated with the symptom severity questionnaire, the GERD-HRQL (best score 0, worst score 50). Later in the series, patients were also evaluated with the generic quality-of-life questionnaire, the SF-36 (best score 100, worst score 0). After antireflux surgery, patients completed both questionnaires 6 weeks postoperatively. A total of 94 patients underwent antireflux surgery. Seventy-seven of them had laparoscopic antireflux surgery (either Nissen or Toupet fundoplication), and 17 had open antireflux surgery (Nissen, Toupet, Collis-Nissen, or Belsey fundoplications). Nine patients had psychiatric disorders (five major depression, four anxiety disorders). At 6-week follow-up, 95.3% of patients without psychiatric disorders were satisfied with surgery, as compared to 11.1% of patients with psychiatric disorders (p < 0.000001). Patients satisfied with surgery had a median SF-36 mental health domain score of 76, as compared to a score of 36 for patients dissatisfied with surgery (p = 0.0002). Patients without psychiatric disorders showed improvement in the median total GERD-HRQL score from 27 preoperatively to 1 postoperatively (p < 0.000001), whereas patients with psychiatric disorders demonstrated less improvement, from 30 preoperatively to 10.5 postoperatively (p = 0.03). Patients with psychiatric disorders are rarely satisfied with the results of antireflux surgery. Moreover, these patients demonstrated less symptomatic relief than patients without psychiatric disorders. Patients who were dissatisfied with antireflux surgery--even those without psychiatric disorders--had lower scores on the SF-36 mental health domain. These results suggest that even patients who might otherwise be candidates for antireflux surgery may have a poor symptomatic outcome, if they also have low mental health domain scores. Antireflux surgery in patients who suffer from major depression or anxiety disorder should be approached with great trepidation.
Article
Psychological aspects such as stress, emotions, illness behaviour or personality are known to affect the severity of symptoms of gastroesophageal reflux disease (GERD) and can influence medical outcome in some patients. The aim of the present study was to evaluate the efficacy of psychological intervention within routine surgical care on the surgical outcome of laparoscopic antireflux surgery (LARS) in patients with stress-related GERD symptoms during a 1-year follow-up. Out of a sample of 196 consecutive patients who required LARS (Nissen fundoplication), a group of 89 (45%) believed that stress was a factor in the cause of their symptoms (stress-related versus stress-unrelated GERD patients). Patients with stress-related symptoms were randomly assigned to the psychological intervention (PI group; n = 42) or control group with routine surgical care (RC group; n =42). Five patients were excluded from the study. Assessments of surgical outcome were: objective clinical data such as DeMeester score or lower oesophageal sphincter pressure, Gastrointestinal Quality-of-Life Index (GIQLI), evaluation of potential side effects such as subjective degree of dysphagia, general impairment as a result of LARS, and patient satisfaction with surgery. There were no significant differences in objective clinical data between the different treatment groups before and after surgery. Before surgery, patients with stress-related symptoms had a lower GIQLI and an increased spectrum of gastrointestinal (GI) symptoms compared with patients without stress-related symptoms. A significant impact (P < 0.05-0.01) of psychological intervention on quality-of-life data, especially in GI symptoms, degree of dysphagia and general impairment, could be calculated after surgery. No differences in satisfaction with therapy were detectable. Comparing outcome, no significant differences between patients without stress-related GERD symptoms and the PI group were found. Generally, quality-of-life data in all patients improved significantly and patient satisfaction was excellent or good in 98.9% one year after surgery. In two patients a laparoscopic refundoplication was necessary because of a 'slipping Nissen'. These findings indicate that there is no impact of psychological intervention on objective clinical data. Patients with stress-related GERD symptoms profit significantly from psychological intervention in patient-related factors of surgical outcome such as quality of life or degree of several aspects such as dysphagia and general impairment. Generally, LARS in patients with stress-related GERD symptoms is an effective and safe procedure which improves quality of life with fewer side effects. Psychological intervention reduces non GERD-related GI symptoms and makes the outcome comparable to the outcome of patients without stress-related symptoms. We therefore suggest that surgical treatment alone in patients with stress-related GERD symptoms is incomplete and that psychological intervention can optimize surgical outcome in these patients.
Article
Several psychological factors are known to affect the subjective outcome, such as quality of life, after laparoscopic antireflux surgery. To evaluate: a. outcome of laparoscopic antireflux surgery in gastro-oesophageal reflux disease patients with concomitant anxiety disorders, b. potential effects of laparoscopic antireflux surgery on psychiatric comorbidities. Out of more than 550 patients who underwent laparoscopic antireflux surgery, 21 suffered from additional anxiety disorders. Outcome assessments included traditional data, evaluation of symptoms and side-effects, and quality of life. These data were evaluated before laparoscopic antireflux surgery and 6 weeks, 3 months and 1 year after surgery, Post-operative lower oesophageal sphincter pressure and DeMeester score were normal in all patients. Subjective severity of anxiety disorders remained unchanged in 13 patients 1 year after surgery. One patient suffered from severe dysphagia and required single dilatation. In this patient, severity and frequency of panic attacks increased for approximately 6 months after laparoscopic antireflux surgery. In 7 patients, total relief of panic symptoms was reported within 3 months post-operatively. Severity of most gastro-oesophageal reflux disease-related symptoms decreased significantly after laparoscopic antireflux surgery, but severity of some symptoms remained stable in patients with continuing anxiety disorders. In all patients, Gastrointestinal Quality of Life Index increased significantly. This improvement was less marked in patients with continuing anxiety disorders. Patients presenting total relief of panic symptoms showed an outcome comparable to normal data. Data obtained suggest that patients with concomitant anxiety disorders should not generally be excluded from laparoscopic antireflux surgery but should be selected more carefully. In these patients, surgery significantly improves quality of life and eliminates gastro-oesophageal reflux disease-related symptoms. Some patients demonstrated less symptomatic relief. In contrast, laparoscopic antireflux surgery was able to eliminate panic disorders in one third of our patients.
Article
: A preliminary study of the relationship between emotional state and esophageal motor function was undertaken. The study involved recording esophageal motility during unstructured psychiatric interviews. A significant relationship between affectively charged material and nonpropulsive activity in the esophagus was consistently found in 2 of 5 subjects and, during some interviews, in other subjects. The method is feasible and reproducible. Copyright (C) 1962 by American Psychosomatic Society
Voluntary relaxation of the esophagus
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Acid gastroesophageal reflux and symptoms occurrence: Analysis of some factors influencing the association
Baldi F, Ferrarini P, Longanesi A, Ragazzini M, Barbara L. Acid gastroesophageal reflux and symptoms occurrence: Ana-lysis of some factors influencing the association. Dig Dis Sci 1989; 34: 1890–1893.
Do heartburn sufferers have a specific personality profile?
  • B T Johnston
  • S A Lewis
  • Love
Johnston B T, Lewis S A, Love A H G. Do heartburn sufferers have a specific personality profile? Gastroenterology 1992; 102: A91.