Anxiety and depression related to the symptoms of gastroesophageal reflux disease

Abstract

To compare the differences in the psychological scale scoring among different subgroups reflux esophagitis (RE) and non-erosive reflux disease (NERD) and to explore the influence of mental factors on the pathogenesis of RE and NERD. Two hundred and six patients with typical heartburn and acid regurgitation underwent endoscopy and esophageal pH monitoring and then were divided into 4 groups: RE+ group (n = 35, 24.3%) with RE and positive pH monitoring results, RH- group (n = 15, 30.0%) with RE and negative pH monitoring results, NERD+ group (n = 77, 40%), with NERD and positive pH monitoring results, and NERD- group (n = 79, 50.6%) with NERD and negative pH monitoring results that was re-divided into 2 subgroups according to the symptom index (SI): NERD-SI+ group (n = 18, 22.8%) with positive symptom index and NERD-SI- group (n = 61, 77.2%) with negative SI. The demographic data and body mass index (BMI) were investigated. The psychological questionnaires: Symptom Checklist 90 (SCL-90), and Hospital Anxiety and Depression Scale (HAD) were used. (1) Male patients were dominant in the RE group and RE+ subgroup, while female patients were dominant in the NERD group and NERD+ subgroup. The values of BMI of the RE group and RE+ subgroup were significantly higher than those of the NERD group and NERD+ subgroup. (2) The abnormal pH monitoring rate of the RE group was 70.0%, significantly higher than that of the NERD group (49.4%). The average DeMeester's score of the RE group was 39.3 (96.5), significantly higher than that of the NERD group 13.8 (33.6). The average DeMeester's score of the RE+ group was 68.1 (95.2), significantly higher than that of the NERD+ group 40.1 (64.4). (3) 44.6% (29/65) of the patients presented depression and 36.9% (24/65) had anxiety, most of them were in mild or moderate degree. The scores of most items of each mental scale were significantly higher in the NERD- patients than in the NERD+ patients, especially in the NERD-SI- subgroup. The symptoms of RE+ and NERD+ patients are associated with esophageal acid exposure and the acid reflux in the RE patients is much severer than that in the NERD patients. Anxiety and depression are related to the symptoms of patients without objective evidence of esophageal mucosal injury and acid reflux (NERD-), especially in the symptom index negative subgroup. Visceral hypersensitivity and stress play an important role in the pathogenesis of gastroesophageal reflux.