December 2023
Psychological factors in patients with refractory heartburn and reflux

Psychological factors might be as important as physiological factors in how patients perceive their symptoms. 

Psychological factors are thought to be associated with symptoms attributed to gastro-oesophageal reflux disease (GORD). To explore this relation, researchers at a tertiary referral centre in Belgium have published two reports that involved 393 consecutive adult patients who were evaluated for refractory heartburn or regurgitation (i.e. persistent symptoms despite taking a proton-pump inhibitor twice daily for 12 weeks).

Patients underwent upper endoscopy and 24-hour pH-impedance monitoring and ultimately were classified into four groups: true GORD (98 patients), borderline GORD (85), reflux hypersensitivity (77) and functional heartburn (133).

All patients completed several questionnaires to assess symptom severity and psychosocial functioning. Two key findings were as follows:

  • psychological factors (e.g. depressive symptoms) correlated with symptom severity, but physiological variables (e.g. number of reflux events and acid exposure time during 24 hours) did not
  • the prevalence and severity of psychological symptoms was similar across the four groups; in other words, psychological symptoms were just as prevalent in the two groups with documented physiological abnormalities (the true and borderline GORD groups) as in the two groups without compelling physiological abnormalities (the reflux hypersensitivity and functional heartburn groups).

Comment: Psychological factors appeared to influence how patients with refractory heartburn and reflux perceived and reported their symptoms, regardless of whether thorough oesophageal evaluation suggested an ‘organic’ or ‘functional’ disorder in a given patient. The authors recommend that clinicians screen patients with refractory GORD symptoms for depression and anxiety and note that behavioural therapies have proven to be beneficial in some studies.

Allan S. Brett, MD, Clinical Professor of Medicine, University of Colorado School of Medicine, Aurora, USA.

Guadagnoli L, et al. Psychological processes, not physiological parameters, are most important contributors to symptom severity in patients with refractory heartburn/regurgitation symptoms. Gastroenterology 2023 Oct; 165: 848-860.

Geeraerts A, et al. Psychological symptoms do not discriminate between reflux phenotypes along the organic-functional refractory GERD spectrum. Gut 2023; 72: 1819-1827.

This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine, Psychiatry.

Gastroenterology, Gut