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Minor psychiatric disorders and objective diagnosis of gastroesophageal reflux disease



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.


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).


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.


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.

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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.

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Authors and Affiliations



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.

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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.

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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).

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