# Psychological Distress Increases GERD Severity



## Jeffrey Roberts (Apr 15, 1987)

*ACG: Psychological Distress Increases GERD Severity* By Charles Bankhead, Staff Writer, MedPage TodayReviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine.October 16, 2007 MedPage Today Action Points 
Explain to interested patients that psychological distress is associated with more severe GERD symptoms.
Point out that patients with psychological distress respond as well to acid suppressive therapy as those without psychological distress but may have more residual symptoms.
Note that the findings were reported at a medical conference and as a published abstract and should be considered preliminary until they have appeared in a peer-reviewed journal.
 ReviewPHILADELPHIA, Oct. 16 -- Apparent treatment-resistant gastroesophageal reflux disease may reflect comorbid psychological distress that results in more severe symptoms, results of a study reported here suggest. About 40% of patients with GERD have comorbid psychological distress, William Chey, M.D., of the University of Michigan at Ann Arbor said at the American College of Gastroenterology meeting. As a consequence, many of the patients will have residual symptoms despite acid-suppressive therapy with PPIs. "The residual symptoms could be mistakenly interpreted as lack of treatment response when, in fact, they represent more severe GERD," said Dr. Chey. The exacerbating effect of psychological distress could help explain why about 30% of GERD patients have incomplete symptom relief with PPI therapy, he added. To determine the prevalence of comorbid psychological distress and assess its impact on response to PPI therapy, Dr. Chey and colleagues studied 101 patients who underwent esophagogastroduodenoscopy for evaluation of persistent heartburn. Testing revealed that 67 patients had nonerosive reflux disease and 34 had erosive esophagitis. At enrollment each patient completed health-related surveys designed to assess GERD symptoms and severity, quality of life, and psychological status. Patients with a score greater than 63 on the Brief Symptom Inventory were defined as having psychological distress. "A BSI of 63 actually defines significant psychological distress," said Dr. Chey. "We set the bar pretty high. These patients were significantly distressed." All patients received treatment with open-label rabeprazole (Aciphex) 20 mg/d. After eight weeks of PPI therapy, the health-related surveys were administered again. Overall, 39% of the patients had comorbid psychological distress. The prevalence of concomitant psychological symptomatology did not differ between patients with nonerosive or erosive disease, said Dr. Chey. Although some of the patients were on antidepressants, most had not been diagnosed with psychological disorders. Patients with comorbid psychological distress had more severe GERD symptoms at enrollment, reflected in a mean Digestive Health Symptom Index score of 41.8 versus 33.6 for patients without psychological distress (P=0.02). After eight weeks of PPI therapy, patients with comorbid psychological distress remained significantly more symptomatic (DHSI 23.1 versus 13.6, P=0.01). However, patients with and without psychological distress had the same degree of symptom improvement with PPI therapy (P<0.0001, baseline versus eight weeks). Patients with comorbid psychological distress had significantly lower quality of life at baseline (P<0.001) and after PPI therapy (P=0.006). However, patients had similar improvement with treatment regardless of baseline psychological status (P<0.0001). In multivariable analyses, the results remained unchanged regardless of patient age, gender, or the presence or absence of irritable bowel syndrome. The findings dispute the widely held assumption that patients with GERD and comorbid psychological distress are more likely to fail PPI therapy, said Dr. Chey. Patients with and without psychological distress improve to a similar degree, but those with psychological distress have more residual symptoms because they had more severe baseline symptoms, he said. Some of the residual symptomatology probably is caused by acid reflux, but most of it probably is not, he continued. The findings, Dr. Chey said, suggest a more generalized process, such as increased visceral hypersensitivity resulting from differences in cortical processing, a hypothesis proposed for irritable bowel syndrome. Dr. Chey is a consultant for Esai, Santarus, and TAP, a member of the Santarus and TAP speaker's bureaus, and has received grant support from Esai. Primary source: American College of GastroenterologySource reference: Chey WD et al. "Prevalence and impact of comorbid psychological distress on response to PPI therapy in patients with GERD." American College of Gastroenterology Annual Meeting and Postgraduate Course. Oct. 12-17, 2007. Philadelphia. Final Program. Abstract P374. --------------------------------------------------------------------------------Disclaimer The information presented in this activity is that of the authors and does not necessarily represent the views of the University of Pennsylvania School of Medicine, MedPage Today, and the commercial supporter. Specific medicines discussed in this activity may not yet be approved by the FDA for the use as indicated by the writer or reviewer. Before prescribing any medication, we advise you to review the complete prescribing information, including indications, contraindications, warnings, precautions, and adverse effects. Specific patient care decisions are the responsibility of the healthcare professional caring for the patient. Please review our Terms of Use. © 2004-2007 MedPage Today, LLC. All Rights Reserved.


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