Patients With Refractory GERD Should Be Screened for Psychological Symptoms

In patients with GERD, there is a need to understand the poor symptom-reflux association and the potential role of psychological processes in reporting esophageal symptom severity. By investigating the impact of various factors on symptom frequency and intensity, including the study outcomes of overall GERD symptoms, heartburn, and sleep disturbance, this study aimed to shed light on similarities and differences across reflux classifications. 

Consecutive adult patients (n=393; mean age, 48.5 years [standard deviation, 14.1]; 60% female) with refractory heartburn/regurgitation symptoms underwent 24-hour pH-impedance monitoring and completed a questionnaire on their gastrointestinal and psychological health. The investigators used two different approaches for analysis: the traditional statistical approach and the machine-learning approach. 

The results showed that general psychological functioning was a significant variable associated with all 3 outcomes, and it mediated the relationship between childhood trauma and both total reflux and heartburn severity. Machine-learning analyses revealed that general psychological variables (e.g., depressive symptoms) contributed the most to total reflux and sleep disturbance outcomes; however, symptom-specific variables, such as visceral anxiety, were more significant for heartburn severity. In contrast, physiological variables did not significantly affect reflux symptom severity outcomes across reflux classifications and statistical methodologies in the sample.