Severe Gastro-oesophageal Reflux Symptoms in Relation to Anxiety, Depression and Coping in a Population-Based Study

C. Jansson; H. Nordenstedt; M.-A. Wallander; S. Johansson; R. Johnsen; K. Hveem; J. Lagergren


Aliment Pharmacol Ther. 2007;26(5):683-691. 

In This Article

Summary and Introduction


Background: The association between psychiatric disorders and gastro-oesophageal reflux symptoms is uncertain, and few population-based studies are available.
Aim: To examine the association between psychiatric and psychological factors and reflux symptoms.
Methods: Population-based, cross-sectional, case-control study based on two health surveys conducted in the Norwegian county Nord-Trondelag in 1984-1986 and 1995-1997. Reflux symptoms were assessed in the second survey, including 65 333 participants (70% of the county's adult population). 3153 subjects reporting severe reflux symptoms were defined as cases and 40 210 subjects without symptoms were defined as controls. Data were collected in questionnaires. Odds ratio with 95% confidence intervals were estimated using unconditional logistic regression, in adjusted models.
Results: Subjects reporting anxiety without depression had a 3.2-fold (95% CI: 2.7-3.8) increased risk of reflux, subjects with depression without anxiety had a 1.7-fold (95% CI: 1.4-2.1) increased risk and subjects with both anxiety and depression had a 2.8-fold (95% CI: 2.4-3.2) increased risk, compared to subjects without anxiety/depression. We observed a weak inverse association between one measure of covert coping and risk of reflux and a weak positive association between another coping measure and risk of reflux.
Conclusions: This population-based study indicates that anxiety and depression are strongly associated with reflux symptoms, while no consistent association regarding coping and reflux was found.


Gastro-oesophageal reflux disease (GERD) is a common health problem, affecting about 10-20% of adult populations at least weekly in the Western world.[1,2,3] GERD is defined as a condition that develops when the reflux of stomach contents causes troublesome symptoms and/or complications,[4] and the cardinal symptoms of GERD are heartburn and acid regurgitation.[5] Frequent or severe reflux symptoms are associated with a substantial risk of morbidity, including oesophageal adenocarcinoma,[6,7] impaired health-related quality of life[8,9] and reduced work productivity.[10,11]

High body mass index (BMI)[2,3,12,13,14] and tobacco smoking[2,13,15,16] have consistently been associated with an increased prevalence of GERD, but the aetiology of this disease remains incompletely understood.[13] Thus, identifying further modifiable risk factors associated with GERD could be of considerable public health importance.[14]

Anxiety and depression are the most common psychiatric disorders among the adult population in the Western world.[17] These disorders are often found co-existing with chronic medical conditions such as cardiovascular disease and diabetes mellitus, and there is an increasing focus on the interplay between anxiety, depression and medical illness.[18] These psychiatric disorders may negatively influence somatic illness, and many diseases increase the risk of suffering from depression and anxiety.[18] Psychological factors and psychiatric disorders may similarly influence gastrointestinal disorders, such as GERD,[19,20] but the relation between these factors and reflux disease is largely uninvestigated.[21,22] Most previous studies have been performed under laboratory experimental conditions in clinical settings, and did not consider everyday situations or include a comparison group of individuals without GERD.[19] To understand the association between psychiatric disorders and GERD population-based studies are needed, as samples recruited among patients constitute selected groups.[23] Similarly, no population-based studies have examined the association between psychological factors such as coping and GERD. Coping has been suggested as an important factor between stressful events and outcomes such as depression, psychological symptoms and somatic illness[24] and it has been hypothesized that psychosocial factors that arouse anger may cause illness, particularly if a subject is not allowed to show anger or to deal constructively with the factor that provoked it.[25]

The aim of this study was to examine the association between psychiatric and psychological factors and reflux symptoms using a large Norwegian population-based case-control study.


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