Spotlight on psychological factors and GERD

Two recent studies focused on the association between psychological factors and gastroesophageal reflux disease (GERD).

The first study, a systematic review and meta-analysis, found that up to one in three patients with GERD also may have anxiety or depression. Based on 26 studies that investigated anxiety symptoms diagnosed by validated questionnaires among 10,378 patients with GERD, the pooled prevalence of anxiety symptoms was 34.4% (95% CI, 24.7% to 44.2%; P<0.001), according to results published July 19 by the American Journal of Gastroenterology. Based on 30 studies that investigated depressive symptoms among 14,030 patients with GERD, the pooled prevalence of depressive symptoms was 24.2% (95% CI, 19.9% to 28.5%; P<0.001) in patients with GERD. Both anxiety and depressive symptoms were more common in patients with GERD compared to healthy controls (odds ratios, 4.46 [95% CI, 1.94 to 10.25] and 2.56 [95% CI, 1.11 to 5.87] based on four and five studies, respectively, with high heterogeneity between studies). Three additional cohort studies also found that patients with GERD were at increased risk for anxiety or depression, and vice versa. In addition, three Mendelian randomization studies showed that genetic predisposition to these mood disorders is linked to an increased risk of developing GERD, and vice versa.

Limitations of the study include high heterogeneity observed between the prevalence studies in some of the included analyses, the authors noted. They added that the meta-analysis could not assess the correlation between the severity of anxiety and depression and the severity of GERD symptoms due to a lack of data, among other limitations. “Assessment for comorbid anxiety and depression in patients with GERD and screening for GERD in anxious/depressive patients may have implications for clinical outcomes and quality of life,” they wrote. “However, further testing in controlled studies is needed.”

The second study found that psychological factors may be more strongly associated with reflux symptom severity than physiological factors. Researchers looked at a cohort of consecutive adult patients who between 2009 and 2014 were referred for 24-hour pH monitoring and multichannel intraluminal impedance due to refractory heartburn/regurgitation symptoms (i.e., symptoms continued after completing at least 12 weeks of proton-pump inhibitor treatment) at a tertiary care center. Participants completed psychological questionnaires assessing several aspects of psychosocial health (e.g., history of childhood trauma, depressive and anxiety symptoms, body- and illness-specific psychosocial functioning) at the clinic visit. The researchers assessed three outcome variables based on responses to the ReQuest, a six-item self-report questionnaire: total reflux severity, heartburn severity, and sleep disturbance. Results were published June 30 by Gastroenterology.

The study included 393 patients (mean age, 48 years; 60% female), 98 classified as having true GERD, 85 borderline GERD, 77 reflux hypersensitivity, and 133 functional heartburn. Psychological symptoms were the most important contributors to reflux symptom severity. In the traditional statistical approach, the general psychological health component was significantly and independently associated with all three outcome variables and mediated the relationship between childhood trauma and severity scores for both total reflux severity and heartburn severity. Results from a machine-learning approach complemented these findings for both total reflux severity and sleep disturbance. Two variables stood out in terms of importance, depressive symptoms and post-traumatic stress symptoms, followed by illness behavior, pain anxiety, trait anxiety, and body awareness, whereas reflux variables had less effect. “However, as our data are cross-sectional, future research should investigate whether modulating psychological symptoms impacts both reflux and sleep-related severity, in the context of GERD,” the authors wrote.