Important Correlation Between Anxiety and Reflux Symptoms in Patients With Gastroesophageal Reflux Disease

Introduction:

Gastroesophageal reflux disease (GERD) is one of the most common gastroenterological disorders with a reported prevalence of 10% to 20% percent in Europe and the USA and less than 5% in Asia. GERD manifests as heartburn, regurgitation, retrosternal pain, cough, and in some cases dysphagia and holds the possible complication of a Barrett´s esophagus. GERD can appear as non-erosive (NERD) or erosive (ERD). In the diagnosis of the reflux disease the DeMeester score is used as a measure of esophageal acid exposure time. Important differential diagnosis are benign functional disorders of the esophagus such as is functional heartburn or functional dysphagia. Comorbid symptoms of anxiety and depression are common: The association between anxiety or depression and reflux symptoms has been investigated in previous studies under the aspects of whether existing reflux symptomatology leads to increased anxiety and depression or whether anxiety and depression lead to more severe reflux symptoms. The results are inconsistent: In younger patients (18 - 40 years) with gastroesophageal reflux disease (GERD) the prevalence of anxiety and depression is higher than in those without GERD. There is an independent association between GERD, anxiety and current depression. Patients with anxiety are more likely to experience GERD symptoms and these symptoms seem to be more severe in anxious patients. Anxiety and depression intensify symptom perception. Patients with GERD have a higher incidence of anxiety, depression and sleep disturbances than those without GERD, and there is an association between psychosocial disorders and an increased risk of anxiety. Thus, there is a an interaction between GERD and psychosocial disorders, which has been discussed as the "psychoemotional effects of GERD". GERD is considered to be an independent source of stress.

A long duration of GERD was associated with higher levels of anxiety and depression, and women were more likely to have these symptoms. In patients with Barrett's esophagus, a complication of GERD in which the mucosal cells of the esophagus, under constant exposure to stomach acid, change into a different type of cell normally found in the intestinal tract, rates of anxiety and depression have been reported to be three to five times higher than in the general population.

Anxiety and depression as well as adverse events in life are also independent risk factors for NERD. Patients with NERD show an increased risk for anxiety compared with patients with ERD.

The reporting of somatic symptoms is multifactorial and influenced by psychosocial factors such as socioeconomic status, sex and mental distress. A high somatic symptom load is known to increase anxiety related to health issues, psychological distress and health care utilization. The increased sensation to visceral stimuli in which anxiety and depression play an important role has been discussed as visceral hypersensitivity.