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Finding relief for the self-conscious esophagus: laparoscopic anti-reflux surgery and the esophageal hypersensitivity and anxiety scale

  • 2021 SAGES Oral
  • Published:
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Abstract

Introduction

Measures of mood and effective coping strategies have notable correlations with quality of life and treatment responses. There is evidence that patients with previously diagnosed anxiety disorders have less improvement in patient-reported outcome measures (PROMs) after laparoscopic anti-reflux surgery (LARS) and that objective pathology does not correlate well with symptom severity. We were interested in investigating whether anxiety and hypervigilance, as measured preoperatively with the esophageal hypervigilance anxiety scale (EHAS), is associated with the improvement in GERD-specific PROMs and EHAS scores 6 months after LARS.

Methods

We performed a retrospective cohort study of 102 adult patients (31% men, average age 64) who underwent LARS. In the preoperative evaluation, baseline gastroesophageal reflux disease-health-related quality of life (GERD-HRQL), laryngopharyngeal reflux symptom index (LPR-RSI) and EHAS scores were collected in addition to the standard reflux workup, including endoscopy, manometry, barium swallow, and pH study. For all three surveys, a higher score represents worse symptom severity. At 6 months postoperatively, 70 patients completed repeat GERD-HRQL, LPR-RSI, and EHAS surveys. We then analyzed for surgical and patient-related factors associated with improvement in the 6-month postoperative GERD-HRQL and LPR-RSI scores.

Results

There was a statistically significant decrease in the GERD-HRQL (25 vs. 2, p < 0.001), LPR-RSI (17 vs. 3, p < 0.001) and EHAS (34 vs. 15, p < 0.001) 6 months after LARS. On multivariable linear regression, a higher baseline EHAS score was independently associated with a greater improvement in GERD-HRQL (β 0.35, p < 0.001) and LPR-RSI (β 0.19, p = 0.03) 6-months after LARS. Additionally, the degree of improvement in EHAS, GERD-HRQL, and LPR-RSI was not influenced by the type of LARS performed or by the severity of disease.

Conclusion

These findings are consistent with literature suggesting that measures of psychoemotional health correlate better with symptom intensity than objective pathology. We found that patients with a higher EHAS score have greater symptom severity and lower quality of life at baseline. Novel findings to this study are that patients with a higher preoperative EHAS, a measure of psychoemotional health, actually benefitted more from surgery and not less, which has been the traditional view in the literature. Future studies are warranted to establish directionality and explore the role of preoperative cognitive behavioral therapy with LARS for patients with significant symptoms of hypervigilance and anxiety.

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References

  1. Gong EJ, Choi KD, Jung HK et al (2017) Quality of life, patient satisfaction, and disease burden in patients with gastroesophageal reflux disease with or without laryngopharyngeal reflux symptoms. J Gastroenterol Hepatol 32(7):1336–1340. https://doi.org/10.1111/jgh.13716

    Article  PubMed  Google Scholar 

  2. Ness-Jensen E, Hveem K, El-Serag H, Lagergren J (2016) Lifestyle intervention in gastroesophageal reflux disease. Clin Gastroenterol Hepatol 14(2):175–182

    Article  Google Scholar 

  3. Maret-Ouda J, Wahlin K, El-Serag HB, Lagergren J (2017) Association between laparoscopic antireflux surgery and recurrence of gastroesophageal reflux. JAMA 318(10):939–946

    Article  Google Scholar 

  4. Yadlapati R, Adkins C, Jaiyeola D-M et al (2016) Abilities of oropharyngeal pH tests and salivary pepsin analysis to discriminate between asymptomatic volunteers and subjects with symptoms of laryngeal irritation. Clin Gastroenterol Hepatol 14(4):535–542

    Article  CAS  Google Scholar 

  5. Wiklund I (2004) Review of the quality of life and burden of illness in gastroesophageal reflux disease. Dig Dis 22(2):108–114

    Article  Google Scholar 

  6. Tack J, Becher A, Mulligan C, Johnson DA (2012) Systematic review: the burden of disruptive gastro-oesophageal reflux disease on health-related quality of life. Aliment Pharmacol Ther 35(11):1257–1266. https://doi.org/10.1111/j.1365-2036.2012.05086.x

    Article  CAS  PubMed  Google Scholar 

  7. Spechler SJ, Hunter JG, Jones KM et al (2019) Randomized trial of medical versus surgical treatment for refractory heartburn. N Engl J Med 381(16):1513–1523

    Article  Google Scholar 

  8. Emken B-EG, Lundell LR, Wallin L et al (2017) Effects of omeprazole or anti-reflux surgery on lower oesophageal sphincter characteristics and oesophageal acid exposure over 10 years. Scand J Gastroenterol 52(1):11–17

    Article  CAS  Google Scholar 

  9. Francis DO, Patel DA, Sharda R et al (2016) Patient-reported outcome measures related to laryngopharyngeal reflux: a systematic review of instrument development and validation. Otolaryngol Head Neck Surg 155(6):923–935

    Article  Google Scholar 

  10. Taft TH, Triggs JR, Carlson DA et al (2018) Validation of the oesophageal hypervigilance and anxiety scale for chronic oesophageal disease. Aliment Pharmacol Ther 47(9):1270–1277. https://doi.org/10.1111/apt.14605

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Hill C, Versluijs Y, Furay E et al (2020) Psychoemotional factors and their influence on the quality of life in patients with GERD. Surg Endosc 2020:1–8

    Google Scholar 

  12. Choi JM, Yang JI, Kang SJ et al (2018) Association between anxiety and depression and gastroesophageal reflux disease: results from a large cross-sectional study. J Neurogastroenterol and Motil 24(4):593

    Article  Google Scholar 

  13. Yang XJ, Jiang HM, Hou XH, Song J (2015) Anxiety and depression in patients with gastroesophageal reflux disease and their effect on quality of life. World J Gastroenterol 21(14):4302–4309. https://doi.org/10.3748/wjg.v21.i14.4302

    Article  PubMed  PubMed Central  Google Scholar 

  14. Kessing BF, Bredenoord AJ, Saleh CM, Smout AJ (2015) Effects of anxiety and depression in patients with gastroesophageal reflux disease. Clin Gastroenterol Hepatol 13(6):1089–1095

    Article  Google Scholar 

  15. Levy S, Plymale M, Davenport DL, Ponte OIM, Roth JS (2014) Patient symptoms correlate poorly with objective measures among patients with gastroesophageal reflux disease. Am Surg 80(9):901–905

    Article  Google Scholar 

  16. Kothari BL, Borgert AJ, Kallies KJ, Kothari SN (2020) Lack of correlation between subjective and objective measures of gastroesophageal reflux disease: call for a novel validated assessment tool. Surg Innov 2020:1553350620955031

    Google Scholar 

  17. Kao S-S, Chen W-C, Hsu P-I et al (2013) The frequencies of gastroesophageal and extragastroesophageal symptoms in patients with mild erosive esophagitis, severe erosive esophagitis, and barrett’s esophagus in Taiwan. Gastroenterol Res Pract 2013:480325

    Article  Google Scholar 

  18. Bradley LA, Richter JE, Pulliam TJ et al (1993) The relationship between stress and symptoms of gastroesophageal reflux: the influence of psychological factors. Am J Gastroenterol 88(1):9

    Google Scholar 

  19. Levine D, Hamelin B, Magner D, Rogers P, Barret R, Joelsson B (1999) Correlation between patient demographics and heartburn severity with Los Angeles (LA) classification of erosive esophagitis. Am J Gastroenterol 94:2591

    Google Scholar 

  20. Haug TT, Mykletun A, Dahl AA (2002) Are anxiety and depression related to gastrointestinal symptoms in the general population? Scand J Gastroenterol 37(3):294–298. https://doi.org/10.1080/003655202317284192

    Article  PubMed  Google Scholar 

  21. Smout A (2007) the measurement of non-acid gastro-oesophageal reflux. Aliment Pharmacol Ther 26:7–12

    Article  Google Scholar 

  22. Carlsson R, Dent J, Watts R et al (1998) Gastro-oesophageal reflux disease in primary care: an international study of different treatment strategies with omeprazole. International GORD study group. Eur J Gastroenterol Hepatol 10(2):119–124

    Article  CAS  Google Scholar 

  23. Jansson C, Nordenstedt H, Wallander MA et al (2007) Severe gastro-oesophageal reflux symptoms in relation to anxiety, depression and coping in a population-based study. Aliment Pharmacol Ther 26(5):683–691. https://doi.org/10.1111/j.1365-2036.2007.03411.x

    Article  CAS  PubMed  Google Scholar 

  24. Hu WHC, Wong WM, Lam CLK et al (2002) Anxiety but not depression determines health care-seeking behaviour in Chinese patients with dyspepsia and irritable bowel syndrome: a population-based study. Aliment Pharmacol Ther 16(12):2081–2088. https://doi.org/10.1046/j.1365-2036.2002.01377.x

    Article  CAS  PubMed  Google Scholar 

  25. Aro P, Talley NJ, Ronkainen J et al (2009) Anxiety is associated with uninvestigated and functional dyspepsia (Rome III criteria) in a Swedish population-based study. Gastroenterology 137(1):94–100

    Article  Google Scholar 

  26. Kamolz T, Velanovich V (2002) Psychological and emotional aspects of gastroesophageal reflux disease. Dis Esophagus 15(3):199–203

    Article  CAS  Google Scholar 

  27. Velanovich V (2003) The effect of chronic pain syndromes and psychoemotional disorders on symptomatic and quality-of-life outcomes of antireflux surgery. J Gastrointest Surg 7(1):53–58. https://doi.org/10.1016/s1091-255x(02)00136-1

    Article  PubMed  Google Scholar 

  28. Kamolz T, Granderath FA, Pointner R (2003) Does major depression in patients with gastroesophageal reflux disease affect the outcome of laparoscopic antireflux surgery? Surg Endosc 17(1):55–60. https://doi.org/10.1007/s00464-002-8504-8

    Article  CAS  PubMed  Google Scholar 

  29. Kamolz T, Granderath FA, Bammer T, Pasiut M, Pointner R (2001) Psychological intervention influences the outcome of laparoscopic antireflux surgery in patients with stress-related symptoms of gastroesophageal reflux disease. Scand J Gastroenterol 36(8):800–805. https://doi.org/10.1080/003655201750313306

    Article  CAS  PubMed  Google Scholar 

  30. Kamolz T, Bammer T, Granderath FA, Pointner R (2001) Laparoscopic antireflux surgery in gastro-oesophageal reflux disease patients with concomitant anxiety disorders. Dig Liver Dis 33(8):659–664. https://doi.org/10.1016/s1590-8658(01)80041-4

    Article  CAS  PubMed  Google Scholar 

  31. Velanovich V, Karmy-Jones R (2001) Psychiatric disorders affect outcomes of antireflux operations for gastroesophageal reflux disease. Surg Endosc 15(2):171–175. https://doi.org/10.1007/s004640000318

    Article  CAS  PubMed  Google Scholar 

  32. Lord RV, Kaminski A, Öberg S et al (2002) Absence of gastroesophageal reflux disease in a majority of patients taking acid suppression medications after Nissen fundoplication. J Gastrointest Surg 6(1):3–10

    Article  Google Scholar 

  33. Khajanchee YS, O’Rourke RW, Lockhart B, Patterson EJ, Hansen PD, Swanstrom LL (2002) Postoperative symptoms and failure after antireflux surgery. Arch Surg 137(9):1008–1014

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery and Perioperative Care, University of Texas at Austin, Austin, TX, USA

    Charles Hill, Stephanie Doggett, Elisa Furay & F. P. Buckley

  2. Department of Orthopaedic Surgery, University of Texas at Austin, Austin, TX, USA

    Tom Crijns

  3. Dell Medical School, University of Texas at Austin, Austin, TX, USA

    Yousef Nofal, Katherine Walsh, Derek Yan, Jeremiah Alexander & Cole Holan

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  1. Charles Hill
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  2. Tom Crijns
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Correspondence to Charles Hill.

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Drs. Hill, Crijns, Furay, Buckley, Mr. Nofal, Yan, Holan and Alexander, and Mrs. Walsh and Ms. Doggett have no conflict of interest or financial ties to disclose.

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Hill, C., Crijns, T., Nofal, Y. et al. Finding relief for the self-conscious esophagus: laparoscopic anti-reflux surgery and the esophageal hypersensitivity and anxiety scale. Surg Endosc 36, 7656–7663 (2022). https://doi.org/10.1007/s00464-022-09081-5

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