Skip to main content

Minor psychiatric disorders and objective diagnosis of gastroesophageal reflux disease

Abstract

Background

Symptoms may be unreliable to diagnose gastroesophageal reflux disease (GERD) in patients with minor psychiatric disorders (MPD). This study aims to evaluate the influence of MPD in the diagnosis of GERD.

Methods

We prospectively studied 245 patients (based on a sample size calculation) with suspected GERD. All patients underwent manometry and pH monitoring and MPD evaluation based on the Hospital Anxiety and Depression Scale (HADS).

Results

Based on the results of the pH monitoring, patients were classified as GERD + (n = 136, 55% of the total, mean age 46 years, 47% females) or GERD − (n = 109, 45% of the total, mean age 43 years, 60% females). The mean HADS score for GERD + and GERD − for anxiety was 7.8 and 8.5, respectively (p = 0.8) and for depression was 5.4 and 6.1, respectively (p = 0.1). DeMeester score (DS) did not correlate with total HADS score (p = 0.08) or depression domain (p = 0.9) but there was a negative correlation between DS and anxiety level (p < 0.001). A significant threshold accuracy value for HADS to diagnose GERD was not found on receiver operating characteristics curve analysis.

Conclusion

Almost half of the patients evaluated for GERD did not have the disease on objective evaluation. GERD + and GERD − patients had similar levels of MPD. However, the amount of reflux correlated negatively with the severity of anxiety. Symptoms and HADS cannot accurately diagnose or exclude GERD. pH monitoring should be more liberally used especially in patients with high levels of anxiety.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  1. Vakil N et al (2006) The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol 101(8):1900–1920. (quiz 1943)

    Article  Google Scholar 

  2. El-Serag HB et al (2014) Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut 63(6):871–880

    Article  Google Scholar 

  3. Dent J et al (2010) Accuracy of the diagnosis of GORD by questionnaire, physicians and a trial of proton pump inhibitor treatment: the Diamond Study. Gut 59(6):714–721

    Article  Google Scholar 

  4. Nasi A et al (2001) Gastroesophageal reflux disease: comparison between patients with and without esophagitis, concerning age, gender and symptoms. Arq Gastroenterol 38(2):109–115

    CAS  Article  Google Scholar 

  5. Moraes-Filho JP et al (2010) Guidelines for the diagnosis and management of gastroesophageal reflux disease: an evidence-based consensus. Arq Gastroenterol 47(1):99–115

    Article  Google Scholar 

  6. Andolfi C et al (2016) Importance of esophageal manometry and pH monitoring in the evaluation of patients with refractory gastroesophageal reflux disease: a multicenter study. J Laparoendosc Adv Surg Tech A 26(7):548–550

    Article  Google Scholar 

  7. Olden KW (2008) Psychosocial factors in functional gastrointestinal disorders: an evolving phenomenon. Neurogastroenterol Motil 20(Suppl 1):114–120

    Article  Google Scholar 

  8. Aziz Q et al (2016) Functional esophageal disorders. Gastroenterology. https://doi.org/10.1053/j.gastro.2016.02.012

    Article  Google Scholar 

  9. Nunez-Rodriguez MH, Miranda A, Sivelo (2008) Psychological factors in gastroesophageal reflux disease measured by scl-90-R questionnaire. Dig Dis Sci 53(12):3071–3075

    Article  Google Scholar 

  10. Lee KJ et al (2009) Demographic, clinical, and psychological characteristics of the heartburn groups classified using the Rome III criteria and factors associated with the responsiveness to proton pump inhibitors in the gastroesophageal reflux disease group. Digestion 79(3):131–136

    CAS  Article  Google Scholar 

  11. Wiklund I et al (2006) Psychological factors as a predictor of treatment response in patients with heartburn: a pooled analysis of clinical trials. Scand J Gastroenterol 41(3):288–293

    Article  Google Scholar 

  12. Velanovich V, Karmy-Jones R (2001) Psychiatric disorders affect outcomes of antireflux operations for gastroesophageal reflux disease. Surg Endosc 15(2):171–175

    CAS  Article  Google Scholar 

  13. Del Grande LM, Herbella FA, Bigatao AM, Abrao H, Jardim JR, Patti MG (2016) Pathophysiology of gastroesophageal reflux in patients with chronic pulmonary obstructive disease is linked to an increased transdiaphragmatic pressure gradient and not to a defective esophagogastric barrier. J Gastrointest Surg 20(1):104–110

    Article  Google Scholar 

  14. DeMeester TR et al (1980) Technique, indications, and clinical use of 24 hour esophageal pH monitoring. J Thorac Cardiovasc Surg 79(5):656–670

    CAS  PubMed  Google Scholar 

  15. Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67(6):361–370

    CAS  Article  Google Scholar 

  16. Andrade LH et al (2012) Mental disorders in megacities: findings from the Sao Paulo megacity mental health survey, Brazil. PLoS ONE 7(2):e31879

    CAS  Article  Google Scholar 

  17. Avidan B et al (2001) Reflux symptoms are associated with psychiatric disease. Aliment Pharmacol Ther 15(12):1907–1912

    CAS  Article  Google Scholar 

  18. Martin-Merino E et al (2010) Depression and treatment with antidepressants are associated with the development of gastro-oesophageal reflux disease. Aliment Pharmacol Ther 31(10):1132–1140

    CAS  PubMed  Google Scholar 

  19. Hartono JL, Mahadeva S, Goh KL (2012) Anxiety and depression in various functional gastrointestinal disorders: do differences exist? J Dig Dis 13(5):252–257

    Article  Google Scholar 

  20. Jansson C 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

    CAS  Article  Google Scholar 

  21. Baker LH, Lieberman D, Oehlke M (1995) Psychological distress in patients with gastroesophageal reflux disease. Am J Gastroenterol 90(10):1797–1803

    CAS  PubMed  Google Scholar 

  22. Mykletun A et al (2010) Prevalence of mood and anxiety disorder in self reported irritable bowel syndrome (IBS). An epidemiological population based study of women. BMC Gastroenterol 10:88

    Article  Google Scholar 

  23. Kessing BF et al (2015) Effects of anxiety and depression in patients with gastroesophageal reflux disease. Clin Gastroenterol Hepatol 13(6):1089–195.e1

    Article  Google Scholar 

  24. Neto SC et al (2014) Ratio between proximal/distal gastroesophageal reflux does not discriminate abnormal proximal reflux. World J Surg 38(4):890–896

    Article  Google Scholar 

  25. Oh JH et al (2009) Relationship between psychological factors and quality of life in subtypes of gastroesophageal reflux disease. Gut Liver 3(4):259–265

    Article  Google Scholar 

  26. O’Boyle CJ et al (2002) Preoperative prediction of long-term outcome following laparoscopic fundoplication. ANZ J Surg 72(7):471–475

    Article  Google Scholar 

  27. Taft TH et al (2018) Validation of the oesophageal hypervigilance and anxiety scale for chronic oesophageal disease. Aliment Pharmacol Ther 47(9):1270–1277

    CAS  Article  Google Scholar 

  28. Boltin D et al (2013) Psychological distress is not associated with treatment failure in patients with gastroesophageal reflux disease. J Psychosom Res 75(5):462–466

    Article  Google Scholar 

  29. Yang XJ et al (2015) Anxiety and depression in patients with gastroesophageal reflux disease and their effect on quality of life. World J Gastroenterol 21(14):4302–4309

    Article  Google Scholar 

  30. Kimura Y et al (2016) Persistent reflux symptoms cause anxiety, depression, and mental health and sleep disorders in gastroesophageal reflux disease patients. J Clin Biochem Nutr 59(1):71–77

    CAS  Article  Google Scholar 

  31. Bilgi MM et al (2017) Prevalence of psychiatric comorbidity in symptomatic gastroesophageal reflux subgroups. Dig Dis Sci 62(4):984–993

    Article  Google Scholar 

  32. Okuyama M et al (2017) Associations among gastroesophageal reflux disease, psychological stress, and sleep disturbances in Japanese adults. Scand J Gastroenterol 52(1):44–49

    CAS  Article  Google Scholar 

  33. Javadi S, Shafikhani AA (2017) Anxiety and depression in patients with gastroesophageal reflux disorder. Electron Physician 9(8):5107–5112

    Article  Google Scholar 

Download references

Acknowledgements

We are indebted to Dr. Sun Rein Lin to allow his patients to be included in the study; Ms. Eliane Francisco for her invaluable assistance with IRB bureaucracy and Edkerly Noronha, NP and her team for priceless help to perform the esophageal functions tests.

Author information

Authors and Affiliations

Authors

Contributions

RMLN: Protocol/project development; data collection or management; data analysis; manuscript writing/editing. FAMH: Protocol/project development; data collection or management; data analysis; manuscript writing/editing. AZ: Protocol/project development. VV: Protocol/project development; data collection or management; manuscript writing/editing. BM: Data collection or management. FS: Manuscript writing/editing. MGP: Manuscript writing/editing. All authors contributed sufficiently to be named as authors and are responsible for the manuscript. No professional or ghost writer was hired.

Corresponding author

Correspondence to Fernando A. M. Herbella.

Ethics declarations

Disclosures

Rafael Melillo Laurino Neto, Fernando A. M. Herbella, Andre Zugman, Vic Velanovich, Beth Montera, Francisco Schlottmann, and Marco G. Patti, MD have no conflicts of interest or financial ties to disclose.

Ethical approval

The study protocol was approved by the local Ethics Committee, and written informed consent was obtained from each subject.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Neto, R.M.L., Herbella, F.A.M., Zugman, A. et al. Minor psychiatric disorders and objective diagnosis of gastroesophageal reflux disease. Surg Endosc 33, 4116–4121 (2019). https://doi.org/10.1007/s00464-019-06716-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-019-06716-y

Keywords

  • Gastroesophageal reflux disease
  • Esophageal pH monitoring
  • Anxiety
  • Depression
  • Surveys and questionnaires