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

Fass, Ronnie; Fass, Shira S.

doi:10.1007/s10620-017-4475-4

Cited by 6 publications

(8 citation statements)

References 21 publications

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“…In addition to hypervigilance, symptom‐specific anxiety remained stable across patient groups. Psychological processes, including general and symptom‐specific anxiety, are implicated as important factors in symptom perception in patients with GERD 24‐26 . Interestingly, one study in the Netherlands found the functional heartburn population reported significantly higher anxiety levels compared to the GERD patients, while anxiety levels between the GERD and reflux hypersensitivity patients did not differ 27 .…”

Section: Discussionmentioning

confidence: 99%

“…Psychological processes, including general and symptom-specific anxiety, are implicated as important factors in symptom perception in patients with GERD. [24][25][26] Interestingly, one study in the Netherlands found the functional heartburn population reported significantly higher anxiety levels compared to the GERD patients, while anxiety levels between the GERD and reflux hypersensitivity patients did not differ. 27 One reason for potential differences in our findings could be the authors used the Hospital Anxiety and Depression Scale (HADS), a measure of general anxiety symptoms, as opposed to our study, which evaluated symptom-specific anxiety.…”

Section: Predictors Of Symptom Severity In Gerdmentioning

confidence: 99%

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Esophageal hypervigilance is prevalent across gastroesophageal reflux disease presentations

Guadagnoli

Yadlapati

Taft

et al. 2021

Neurogastroenterology Motil

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Background There is a need to identify factors outside of abnormal reflux that contribute to gastroesophageal reflux disease (GERD). Esophageal hypervigilance is a psychological process impacting symptom experience in esophageal disease. However, little is known about the presence of hypervigilance in GERD phenotypes, especially in those with abnormal acid exposure or symptom index scores. The primary aim was to assess differences in self‐reported esophageal hypervigilance across different GERD presentations. The secondary aim was to evaluate esophageal hypervigilance as a predictor of symptom severity. Methods We conducted retrospective data analyses on a cohort of adult patients with reflux symptoms that underwent 96‐hour wireless pH monitoring from 9/2015 to 9/2017. Patients were stratified into groups based on the number of days they exhibited positive acid exposure time (AET; 0 days, 1–2 days, 3+ days), and symptom index scores (SI; 0 days, 1‐day, 2+ days). Esophageal hypervigilance and anxiety, and symptom frequency and severity were assessed between groups. Key Results A total of 123 AET cases and 116 SI cases were included for analysis. Esophageal hypervigilance and anxiety scores did not significantly differ based on the number of days of positive AET (p = 0.311) or SI (p = 0.118). Symptom severity and perceived symptom frequency differed between groups. Hypervigilance significantly predicted symptom severity, when controlling for symptom‐specific anxiety. Conclusions Esophageal hypervigilance is persistent across patients with reflux, irrespective of acid burden and symptom index, and significantly predicts symptom severity. Hypervigilance should be considered as an independent factor contributing to esophageal symptom perception.

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Section: Discussionmentioning

confidence: 99%

Section: Predictors Of Symptom Severity In Gerdmentioning

confidence: 99%

Esophageal hypervigilance is prevalent across gastroesophageal reflux disease presentations

Guadagnoli

Yadlapati

Taft

et al. 2021

Neurogastroenterology Motil

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“…This brings attention to the concern with self-treating heartburn without a formal diagnosis. An additional concern is warranted in that several studies have shown that patients with a psychiatric diagnosis are more likely to report heartburn and dysphagia [36,[38][39][40]. When evaluating psychological comorbidities and heartburn groups, researchers found that depression was significantly more common in heartburn disorders in comparison to healthy controls, and that major depression was significantly more common in functional heartburn patients and anxiety more common in hypersensitive esophagus and erosive esophagitis [35,37,39].…”

Section: Heartburnmentioning

confidence: 99%

One-dollar medications: evaluating the true cost

Shea

Sorauf

Polson

et al. 2022

ATM

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Introduction: Dollar stores offer access to medications. Reports of adulteration and violations of good manufacturing practice (GMP) of the medications sold at these stores raise concern. Additionally, medications may be used inappropriately for self-treatment, resulting in suboptimal care and safety concerns. Is the cost of one-dollar medications truly a cost saving for consumers? Methods: This was a cross-sectional evaluation of medications sold in dollar stores. Medications were reviewed from December 2018 through July 2021. Researchers evaluated price comparisons of medications sold in dollar stores in comparison to those sold in pharmacies, assessed the quantity of the medication products from the manufacturer that had committed violations of GMP, and conducted a qualitative analysis of the safety of the medications for self- treatment with respect to current guidelines. Mann-Whitney U price analysis was performed between dollar store products and generic pharmacy products. Results: The cost per unit of pain medication was significantly higher for purchases at dollar stores (Mdn = 0.045) in comparison to generic pain medications sold in pharmacies (Mdn = 0.030), W = 251.5, p = 0.013. There was no statistical difference in the costs of all other medications. The majority of the medications (59%) were from the manufacturer that had committed violations of GMP. Only second-line treatment options were available, providing suboptimal treatments and increased risks for adverse effects and poorer control of symptoms. Conclusion: Consumers are not attaining a cost benefit when purchasing dollar store medications. Medications sold in settings in which a healthcare professional is not accessible should be limited to acute use dosing in place of packaging for chronic use. Additionally, further research is needed to determine if the violations determined for medications sold at the dollar store have been remedied.

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“…Acid exposure itself can increase visceral sensitivity by central sensitization, which is facilitated in patients with dilated intracellular spaces that increase exposure of submucosal visceral afferents to noxious chemicals . Clinical studies have shown that patients with anxiety and various forms of stress (e.g., sleep deprivation) have increased likelihood of reporting symptoms in response to reflux events . Therefore, when esophageal symptoms persist despite empiric therapy and when endoscopy does not demonstrate definitive evidence for reflux‐induced mucosal damage, further evaluation typically involves ambulatory reflux monitoring.…”

Section: Introductionmentioning

confidence: 99%

“…7,8 Clinical studies have shown that patients with anxiety and various forms of stress (e.g., sleep deprivation) have increased likelihood of reporting symptoms in response to reflux events. 9,10 Therefore, when esophageal symptoms persist despite empiric therapy and when endoscopy does not demonstrate definitive evidence for refluxinduced mucosal damage, further evaluation typically involves ambulatory reflux monitoring. The purpose of evaluation is to determine if symptoms occur in the setting of abnormal reflux burden, or if functional syndromes (i.e., reflux hypersensitivity and functional heartburn) 3 could be contributing to symptoms.…”

Section: Introductionmentioning

confidence: 99%

Nonerosive reflux disease: clinical concepts

Gyawali

Azagury

Chan

et al. 2018

Annals of the New York Academy of Sciences

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Esophageal symptoms can arise from gastroesophageal reflux disease (GERD) as well as other mucosal and motor processes, structural disease, and functional esophageal syndromes. GERD is the most common esophageal disorder, but diagnosis may not be straightforward when symptoms persist despite empiric acid suppressive therapy and when mucosal erosions are not seen on endoscopy (as for nonerosive reflux disease, NERD). Esophageal physiological tests (ambulatory pH or pH-impedance monitoring and manometry) can be of value in defining abnormal reflux burden and reflux-symptom association. NERD diagnosed on the basis of abnormal reflux burden on ambulatory reflux monitoring is associated with similar symptom response from antireflux therapy for erosive esophagitis. Acid suppression is the mainstay of therapy, and antireflux surgery has a definitive role in the management of persisting symptoms attributed to NERD, especially when the esophagogastric junction is compromised. Adjunctive approaches and complementary therapy may be of additional value in management. In this review, we describe the evaluation, diagnosis, differential diagnosis, and management of NERD.

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

Cited by 6 publications

References 21 publications

Esophageal hypervigilance is prevalent across gastroesophageal reflux disease presentations

Esophageal hypervigilance is prevalent across gastroesophageal reflux disease presentations

One-dollar medications: evaluating the true cost

Nonerosive reflux disease: clinical concepts

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