Oesophageal hypersensitivity is associated with features of psychiatric disorders and the irritable bowel syndrome

Abstract

SUMMARY BackgroundTwenty per cent of patients with heartburn do not respond to proton pump inhibitors (PPIs). Many have normal oesophageal acid exposure. We hypothesized that such PPI non-responders have heightened oesophageal sensation, and that oesophageal hypersensitivity is associated with psychiatric features including somatization and anxiety.

Review article: gastro‐oesophageal reflux disease and psychological comorbidity

“…37 Presently, functional heartburn patients account for most of those who fail PPI treatment. 38,39 Rubenstein et al 40 have also demonstrated that GERD patients have a higher level of somatization and anxiety as compared to normal controls. In addition, psychiatric disorders were associated with lower perception thresholds for oesophageal acid perfusion and balloon distention.…”

“…40,41 GERD patients who also had irritable bowel syndrome perceived their symptoms as more severe and tended not to achieve the same degree of improvement in GERD symptoms while treated with a PPI as those without irritable bowel syndrome. 41 Based on recent data about the contribution of psychological comorbidity to the PPI failure phenomenon, GERD patients who are not responsive to treatment should be evaluated for psychological comorbidity.…”

“…In addition, psychiatric disorders were associated with lower perception thresholds for oesophageal acid perfusion and balloon distention. 40 Consequently, it has been proposed that patients who did not respond to PPI therapy are more likely to have psychosocial comorbidity than those who were successfully treated with a PPI. Nojkov et al 41 provided the first evidence that response to PPI treatment may be associated with the level of psychological distress.…”

Psychological Comorbidity and Chronic Heartburn: Which Is the Chicken and Which Is the Egg?

“…While the data are limited, several studies have suggested that the presence of psychological comorbidity adversely affects the response of patients to proton pump inhibitor (PPI) treatment. High levels of anxiety and depression reduce the likelihood of achieving complete heartburn relief [18,19]. Moreover, the level of psychological distress is an independent predictor for poor response to PPI treatment [20].…”

Therapeutic options for refractory gastroesophageal reflux disease

“…52 Anxiety and depression have been shown to increase GERD-related symptoms report in population-based studies. Nojkov et al provided the first evidence that response to PPI treatment may be dependent on the level of psychological distress.…”