Profile of the Change in Depression during Proton-Pump Inhibitor Therapy in Patients with Gastroesophageal Reflux Disease: Influence of the Mucosal Break.

Chia-Liang Wu,Chien-Lin Chen,Shu-Hui Wen

doi:10.3390/ijerph18115964

Abstract

Given the frequent concomitance between depression and gastroesophageal reflux disease (GERD), it is important to evaluate the change of depression in patients with GERD, especially considering the presence of esophageal mucosal breaks (MB). This study aimed to examine the change in the levels of depression in patients with GERD during proton-pump inhibitors (PPI) therapy. We designed a prospective cohort study to explore the profile of the alteration in depression with respect to the impact of esophageal MB. This study recruited 172 eligible patients with GERD between February 2016 and May 2018. The change in depression was defined as the difference between the respective Taiwanese Depression Questionnaire (TDQ) scores obtained at baseline and after PPI therapy. Multivariate linear regression models were used to estimate the factors associated with the change in depression. The results revealed statistically significant improvements in the TDQ score (mean score: baseline = 13.2, after PPI therapy = 10.9, p < 0.01, Cohen’s d = 0.30) during PPI therapy for GERD. Moreover, the MB was an independent variable associated with changes in the TDQ score [B = 3.31, 95% confidence interval (CI): (1.12, 5.51), p < 0.01] and the improvement in depression [odds ratio = 0.38, 95% CI: (0.17, 0.86), p = 0.02]. Our findings revealed that depressive symptoms improved slightly following PPI therapy. Moreover, MB was an unfavorable prognostic factor for the improvement in depression.

Highlights

Gastroesophageal reflux disease (GERD) is a digestive disorder characterized by the flow of the acidic content of the stomach back into the esophagus
Patients with GERD were defined as those who complained of symptoms such as acid regurgitation and heartburn, which was identified using the reflux disease questionnaire (RDQ) score ≥ 3 [24]
During follow-up, the duration of pump inhibitors (PPI) therapy was longer in the mucosal break (MB) group than in the NoMB group

Summary

Introduction

Gastroesophageal reflux disease (GERD) is a digestive disorder characterized by the flow of the acidic content of the stomach back into the esophagus. The typical symptoms of GERD include heartburn, acid regurgitation, and an acidic taste in the mouth. The health ramifications of GERD include asthma [4], chronic cough [5], esophageal cancer [6], and depression [7], deterioration in the quality of life [3,8], and decrease work productivity [9]. GERD can be divided into erosive reflux disease (ERD) and non-erosive reflux disease (NERD) based on the presence of the esophageal mucosal break (MB). NERD accounts for approximately 70% of cases of GERD [11], and its pathophysiology involves peripheral factors (mucosal, luminal, etc.) and central factors (psychological stress, etc.) [12].

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