S457 Comparison of the Prevalence of Psychiatric Disorders Among Refractory GERD, Functional Heartburn and Reflux Hypersensitivity

Abstract

Introduction: Psychiatric disorders were previously reported to be associated with GERD, including anxiety and depression. Functional heartburn (FH) and reflux hypersensitivity (RH) are functional esophageal disorders which involve dysfunction of the gut-brain axis and information about association with neuropsychiatric disorders remains scarce. The aim of our study was to compare the distribution of psychiatric diseases among FH, RH and refractory GERD populations. Methods: Patients were identified through Epic SlicerDicer with selection criteria of GERD, on proton pump inhibitor (PPI) who received esophageal pH monitoring from 2000-2021. FH cohort consisted of patients who had a negative pH test off PPI before the study and lacked endoscopic abnormalities. Similarly, RH cohort was created by selecting patients with a negative pH test off PPI with no endoscopic abnormalities, but with positive symptom association with gastroesophageal reflux events. The refractory GERD group consisted of patients with a positive pH test while on twice daily PPI. Demographic information and psychiatric history including anxiety, depression, schizophrenia, PTSD, and bipolar disorder as well as psychiatric medications were collected. Data were analyzed using ANOVA, Fisher’s exact test, Chi-square test and odds ratio (OR) with a confidence interval of 95%. Results: FH, RH and refractory GERD cohorts consisted of 61, 22 and 38 patients respectively. There was a significant difference in the prevalence of psychiatric conditions overall and anxiety among FH, RH and refractory GERD group (psych conditions: p=0.024; anxiety: p=0.003) (Table). Specifically, both FH and RH had an overall lower prevalence of psychiatric conditions overall when compared with refractory GERD group (FH vs refractory GERD: OR 0.139-0.843, p=0.018; RH vs refractory GERD: OR 0.084-0.796, p=0.016). There was a lower frequency of anxiety and use of benzodiazepines (Benzo) in FH as compared with the refractory GERD group (Anxiety in FH vs refractory GERD: OR 0.098-0.551, p< 0.001; Benzo in FH vs refractory GERD: OR 0.033-0.493, p< 0.001). Conclusion: Our study found a lower frequency of psychiatric disorders and anxiety in the functional esophageal groups as compared with refractory GERD group. However, further studies are warranted to determine the neuropsychiatric differences across different phenotypes of GERD. Table 1. - Comparison of Psychiatric Disorders and Psychotropic Medications Among Refractory GERD, Functional Heartburn and Reflux Hypersensitivity FH (n=61) RH (n=22) Refractory GERD (n=38) p Age 56.0±1.9 53.3±2.7 57.2±2.3 0.583 BMI 29.1±1.0 30.2±1.5 31.7±1.1 0.269 Gender Male 12 (19.7%) 3 (13.6%) 8 (21.1%) 0.770 Female 49 (80.3%) 19 (86.4%) 30 (78.9%) Psych Overall psychiatric conditions 32 (52.5%) 10 (45.5%) 29 (76.3%) 0.024 Anxiety 16 (26.2%) 8 (36.4%) 23 (60.5%) 0.003 Depression 25 (41.0%) 8 (36.4%) 22 (57.9%) 0.166 Schizophrenia 3 (4.9%) 0 1 (2.6%) 0.521 PTSD 3 (4.9%) 2 (36.4%) 4 (10.5%) 0.555 Bipolar 3 (4.9%) 0 2 (5.3%) 0.558 Medications SSRI 13 (21.3%) 4 (18.2%) 14 (36.8%) 0.150 SNRI 3 (4.9%) 2 (9.1%) 6 (15.8%) 0.190 TCA 6 (10.0%) 2 (9.1%) 3 (7.9%) 0.940 Benzodiazepine 3 (4.9%) 0 11 (28.9%) < 0.001