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Persistent Reflux Symptoms Cause Anxiety, Depression, and Mental Health and Sleep Disorders in Gastroesophageal Reflux Disease Patients


Persistent Reflux Symptoms Cause Anxiety, Depression, and Mental Health and Sleep Disorders in Gastroesophageal Reflux Disease Patients

Yoshihide Kimura et al. J Clin Biochem Nutr.


Some patients with gastroesophageal reflux disease experience persistent reflux symptoms despite proton pump inhibitor therapy. These symptoms reduce their health-related quality of life. Our aims were to evaluate the relationship between proton pump inhibitor efficacy and health-related quality of life and to evaluate predictive factors affecting treatment response in Japanese patients. Using the gastroesophageal reflux disease questionnaire, 145 gastroesophageal reflux disease patients undergoing proton pump inhibitor therapy were evaluated and classified as responders or partial-responders. Their health-related quality of life was then evaluated using the 8-item Short Form Health Survey, the Pittsburgh Sleep Quality Index, and the Hospital Anxiety and Depression Scale questionnaires. Sixty-nine patients (47.6%) were partial responders. These patients had significantly lower scores than responders in 5/8 subscales and in the mental health component summary of the 8-item Short Form Health Survey. Partial responders had significantly higher Pittsburgh Sleep Quality Index and Hospital Anxiety and Depression Scale scores, including anxiety and depression scores, than those of responders. Non-erosive reflux disease and double proton pump inhibitor doses were predictive factors of partial responders. Persistent reflux symptoms, despite proton pump inhibitor therapy, caused mental health disorders, sleep disorders, and psychological distress in Japanese gastroesophageal reflux disease patients.

Keywords: 8-item Short Form Health Survey; Hospital Anxiety and Depression Scale; Pittsburgh Sleep Quality Index; gastroesophageal reflux disease; health-related quality of life.


Fig. 1
Fig. 1
Response rate to proton pump inhibitors (PPIs). Seventy-six patients (52.4%) were identified as responders and 69 patients (47.6%) were identified as partial responders to PPI therapy.
Fig. 2
Fig. 2
(A) 8-item Short Form Health Survey (SF-8) subscale score. GH, general health; PF, physical function; RP, role-physical; BP, bodily pain; VT, vitality; SF, social function; MH, mental health; RE, role-emotional. The GH, VT, SF, MH, and RE scores of the partial responders were significantly lower than those of the responders. *p<0.01, **p<0.001. (B) SF-8 summary score. The mental component summary (MCS) score in partial responders was significantly lower than that in responders. There was no significant difference in physical component summary (PCS) score between responders and partial responders.
Fig. 3
Fig. 3
Comparison of the Pittsburgh Sleep Quality Index (PSQI) scores. The PSQI score was significantly higher in partial responders than in responders.
Fig. 4
Fig. 4
(A) Comparison of Hospital Anxiety and Depression Scale (HADS) scores. The mean HADS-A, HADS-D, and total HADS scores in partial responders were significantly higher than those in responders. *p<0.01, **p<0.001. (B) Comparison of HADS-A and HADS-D states. There was a significant difference in the ratio of anxiety or depression levels between responders and partial responders. The “severe” ratio of partial responders was significantly higher than that of responders and the “mild” ratio of partial responders were significantly lower than that of responders.

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