The Association Between Reflux Esophagitis and Psychosocial Stress
The prevalence of reflux esophagitis is increasing in Korea. Reflux esophagitis aggravates the stress and fatigue level of daily life, but less is known about the association with stress and fatigue, which could be bi-directional.
To evaluate the impact of reflux esophagitis on stress and fatigue and to compare the stress level of people with reflux esophagitis with that of controls with peptic ulcer disease and healthy controls.
Among a total of 9,033 subjects who underwent a comprehensive medical check-up including upper endoscopy, 6,834 subjects (75.7 %) were enrolled. Stress and fatigue scores were measured by a validated Korean version of the Brief Encounter Psychosocial Instrument and the Fatigue Severity Scale.
Among 6,834 subjects, 13.2 % were in the high-stress group, and reflux esophagitis was found in 6.0 %. After adjustment for confounders, reflux esophagitis was significantly associated with high stress (odds ratio 1.94, 95 % confidence interval 1.25–3.02). Subjects with reflux esophagitis had significantly higher BEPSI-K scores compared with healthy controls (p = 0.027); and however, there was no significant difference in BEPSI-K scores between reflux esophagitis group and peptic ulcer disease controls. Fatigue severity scale was highly correlated with BEPSI-K (p < 0.001); however, there was no significant difference in fatigue severity scale level between the reflux esophagitis group and controls. The severity of reflux esophagitis was significantly correlated with BEPSI-K score (p = 0.008).
Reflux esophagitis is significantly associated with psychosocial stress, and the severity of reflux esophagitis correlates with the degree of stress.
- Fock KM, Talley NJ, Fass R, et al. Asia-Pacific consensus on the management of gastroesophageal reflux disease: update. J Gastroenterol Hepatol. 2008;23:8–22. CrossRef
- Wang R, Ma XQ, Cao Y, et al. Burden of gastroesophageal reflux disease in Shanghai, China. Dig Liver Dis. 2009;41:110–115. CrossRef
- Yang SY, Lee OY, Bak YT, et al. Prevalence of gastroesophageal reflux disease symptoms and uninvestigated dyspepsia in Korea: a population-based study. Dig Dis Sci. 2008;53:188–193. CrossRef
- Goh KL, Chang SC, Fock KM, Ke M, Park HJ, Lam SK. Gastro-oesophageal reflux disease in Asia. J Gastroenterol Hepatol. 2000;15:230–238. CrossRef
- Jung HK. Epidemiology of gastroesophageal reflux disease in Asia: a systematic review. J Neurogastroenterol Motil. 2011;17:14–27. CrossRef
- Hemingway H, Marmot M. Evidence based cardiology: psychosocial factors in the aetiology and prognosis of coronary heart disease. Systematic review of prospective cohort studies. BMJ. 1999;318:1460–1467. CrossRef
- Hjemdahl P. Stress and the metabolic syndrome: an interesting but enigmatic association. Circulation. 2002;106:2634–2636. CrossRef
- Bradley LA, Richter JE, Pulliam TJ, et al. The relationship between stress and symptoms of gastroesophageal reflux: the influence of psychological factors. Am J Gastroenterol. 1993;88:11–19.
- Rubin J, Nagler R, Spiro HM, Pilot ML. Measuring the effect of emotions on esophageal motility. Psychosom Med. 1962;24:170–176.
- Holtmann G, Kriebel R, Singer MV. Mental stress and gastric acid secretion. Do personality traits influence the response? Dig Dis Sci. 1990;35:998–1007. CrossRef
- Kulig M, Leodolter A, Vieth M, et al. Quality of life in relation to symptoms in patients with gastro-oesophageal reflux disease– an analysis based on the ProGERD initiative. Aliment Pharmacol Ther. 2003;18:767–776. CrossRef
- Henke CJ, Levin TR, Henning JM, Potter LP. Work loss costs due to peptic ulcer disease and gastroesophageal reflux disease in a health maintenance organization. Am J Gastroenterol. 2000;95:788–792. CrossRef
- Kim N, Lee SW, Cho SI, et al. The prevalence of and risk factors for erosive oesophagitis and non-erosive reflux disease: a nationwide multicentre prospective study in Korea. Aliment Pharmacol Ther. 2008;15:173–185.
- Frank SH, Zyzanski SJ. Stress in the clinical setting: the Brief Encounter Psychosocial Instrument. J Fam Pract. 1988;26:533–539.
- Yim JH, Bae JM, Choi SS. The validity of modified Korean translated BEPSI as instrument of stress measurement in outpatient clinic. J Korean Acad Fam Med. 1996;17:42–49.
- Bae JM, Jeong EK, Yoo TW, Huh BY. A quick measurement for stress in outpatient clinic setting. J Korean Acad Fam Med. 1992;13:809–820.
- Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD. The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol. 1989;46:1121–1123. CrossRef
- Chung KI, Song CH. Clinical usefulness of fatigue severity scale for patients with fatigue, and anxiety or depression. Korean J Psychosom Med. 2001;9:164–173.
- Valko PO, Bassetti CL, Bloch KE, Held U, Baumann CR. Validation of the fatigue severity scale in a Swiss cohort. Sleep. 2008;31:1601–1607.
- Lundell LR, Dent J, Bennett JR, et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut. 1999;45:172–180. CrossRef
- Levy RL, Olden KW, Naliboff BD, et al. Psychosocial aspects of the functional gastrointestinal disorders. Gastroenterology. 2006;130:1447–1458. CrossRef
- Corneille MG, Gallup TM, Villa C, et al. Pediatric vascular injuries: acute management and early outcomes. J Trauma. 2011;70:823–828. CrossRef
- Wright CE, Ebrecht M, Mitchell R, Anggiansah A, Weinman J. The effect of psychological stress on symptom severity and perception in patients with gastro-oesophageal reflux. J Psychosom Res. 2005;59:415–424. CrossRef
- Fass R, Naliboff BD, Fass SS, et al. The effect of auditory stress on perception of intraesophageal acid in patients with gastroesophageal reflux disease. Gastroenterology. 2008;134:696–705. CrossRef
- Richter JE, Bradley LC. Psychophysiological interactions in esophageal diseases. Semin Gastrointest Dis. 1996;7:169–184.
- Peterson WL. The role of acid in upper gastrointestinal haemorrhage due to ulcer and stress-related mucosal damage. Aliment Pharmacol Ther. 1995;9:43–46. CrossRef
- Kahrilas PJ, Gupta RR. Mechanisms of acid reflux associated with cigarette smoking. Gut. 1990;31:4–10. CrossRef
- Vitale GC, Cheadle WG, Patel B, et al. The effect of alcohol on nocturnal gastro-esophageal reflux. JAMA. 1987;258:2077–2079. CrossRef
- Torres SJ, Nowsnon CA. Relationship between stress, eating behavior, and obesity. Nutrition. 2007;23:887–894. CrossRef
- Dore MP, Maragkoudakis E, Fraley K, et al. Diet, lifestyle and gender in gastro-esophageal reflux disease. Dig Dis Sci. 2008;53:2027–2032. CrossRef
- Choi JY, Jung HK, Roh SH, et al. Sleep disorder associated with gastroesophageal reflux disease. Korean J Med. 2011;81:602–610.
- Wang R, Zou D, Ma X, et al. Impact of gastroesophageal reflux disease on daily life: the Systematic Investigation of Gastrointestinal Diseases in China (SILC) epidemiological study. Health Qual Life Outcomes. 2010;8:128. CrossRef
- Jones MP. The role of psychosocial factors in peptic ulcer disease: beyond Helicobacter pylori and NSAIDs. J Psychosom Res. 2006;60:407–412. CrossRef
- Naliboff BD, Mayer M, Fass R, et al. The effect of life stress on symptoms of heartburn. Psychosom Med. 2004;66:426–434. CrossRef
- The Association Between Reflux Esophagitis and Psychosocial Stress
- Open Access
- Available under Open Access This content is freely available online to anyone, anywhere at any time.
Digestive Diseases and Sciences
Volume 58, Issue 2 , pp 471-477
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Gastroesophageal reflux
- Peptic ulcer disease
- Industry Sectors