Article: Gastro-oesophageal Reflux Disease and Psychological Comorbidity

I. Mizyed; S.S. Fass; R. Fass

Disclosures

Aliment Pharmacol Ther. 2009;29(4):351-358. 

In This Article

Psychological Comorbidity in GERD

Gastro-oesophageal reflux disease, with heartburn being the main symptom, is reported by approximately 44% of the US adult population at least once a month.[12] Approximately 7% experience heartburn daily and 14% weekly.[13] Overall, patients with GERD appear to have a high prevalence of various psychological comorbidities. Avidan et al.[14] have demonstrated that heartburn, exercise-induced heartburn and dysphagia are more commonly reported by patients carrying a psychiatric diagnosis than a control group without any psychological comorbidity. The patients had various psychological comorbidities such as bipolar disorder (19%), major depression (18%), paranoid schizophrenia (18%), schizophrenia (16%), alcohol dependence (9%), polysubstance abuse (2%) and borderline personality (1%). All patients with psychological comorbidity were on some type of psychotropic medication, and cigarette smoking was more prevalent in this population than in non-GERD controls. However, none of these factors was significant in the aetiology of GERD in comparison to the mere presence of a psychiatric diagnosis. Additionally, it appeared that reflux symptoms are not associated with any specific type of psychotropic medication and may reflect a generally reduced threshold for distorted perception of symptoms.

Patients with GERD demonstrate significantly higher anxiety and depression scores as compared with normal subjects.[15,16] Psychological characteristics predict likelihood of GERD symptoms.[4] GERD patients with a high frequency of symptoms and long duration of disease have increased psychological distress. However, studies did not find a relationship between psychological comorbidity as determined by the Symptom Checklist-90 Revised (SCL-90-R) and pH testing or endoscopic results.[17]

In a population-based study, 3153 GERD patients were evaluated for psychological comorbidity as compared to 40 210 normal subjects.[18] 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 of reflux, and subjects with both anxiety and depression had a 2.8-fold (95% CI: 2.4-3.2) increased risk of reflux when compared to subjects without anxiety/depression. Baker et al. provided psychological assessment to 51 patients with documented GERD and 43 age-matched controls and found that patients with reflux differed from controls on scales of depression, somatization, anxiety and intensity of reporting symptom distress.[19] Further analysis revealed that psychologically distressed patients (30%) were most likely to be found among the GERD group.

Patients with noncardiac chest pain and nutcracker oesophagus demonstrate gastrointestinal susceptibility and somatic anxiety.[20] Additionally, these patients show a tendency to be hypochondriacal and seek early medical care.[20] Talley et al.[21] found that reflux symptoms were reported by 42% of psychiatric patients as compared to 5% of normal controls. Moreover, patients with complaints of noncardiac chest pain were more frequently found to have a psychiatric diagnosis.[14]

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