Psychological Characteristics in Patients with Persistent Symptoms of Non-erosive Reflux Disease

Introduction: Gastroesophageal reflux disease (GERD) is observed among 10-20% population in the Western world. GERD significantly impacts the health related quality of life (HRQL). Non-erosive reflux disease (NERD) as a distinct presentation of GERD and has been the focus of many studies recently. To date there have been no studies evaluating the role of psychological factors in combination with ambulatory reflux testing to explain symptoms and to find correlations. Methods: Our cross-sectional study included NERD patients who presented to our hospital for ambulatory reflux testing between August 2013 and April 2014, where informed consent was obtained. Four questionnaires (Anxiety Sensitivity Inventory [ASI], Visceral Sensitivity Index [VSI], Discomfort Intolerance [DI] and GERD-HRQL) were completed by each patient. Symptoms occurring within 5 minutes of the detected reflux on impedance testing were deemed reflux-related. Based on reflux testing results, patients were divided into predominant symptom correlation with Acid-Reflux (AR) or non Acid-Reflux (nAR) groups. Endpoints of the study include establishing the relationship between symptoms pertaining to GERD and the psychological characteristics in the context of impedance pH monitoring. Statistical analysis was employed using Microsoft Excel and SAS. Results: Out of 29 NERD patients who underwent ambulatory reflux testing, 21 patients who had a symptom correlation were included. Mean ages 45.7 (SD 14). 66.7% were males, 50% had BMI > 30 and 86% were Caucasians. Comparison of average scores of questionnaire between AR (n=10) and nAR (n=11) groups (Table-1). Patients with a higher BMI (>30) had a significantly higher VSI score (0.02). Ages >45 years had a significantly higher DI score (0.01). No difference in ASI and VSI score for this age group. No gender differences were observed among both groups.Table 1: Comparison of Average Scores of Questionnaire Between Two GroupsConclusion: Due to proven low success rate of proton pump inhibitor (PPI) in patients with NERD (about 50%) new pathways are needed to manage this patient population, especially the psychological aspect of GERD. We concluded that there isn’t a strong relationship between NERD symptoms and the psychological characteristics. However, as we enroll a larger sample, future analysis of our study population may reveal a more significant correlation that might help elucidate new therapeutic approaches.