SAN DIEGO — Regardless of physiologic symptoms and acid exposure, patients across the GERD spectrum regularly experience esophageal hypervigilance and symptom-specific anxiety, according to study results presented at Digestive Disease Week.
“People that are hypervigilant are highly focused on the esophagus, on the sensations and any foods that may cause symptoms,” Livia Guadagnoli, a clinical psychology doctoral candidate at the Northwestern University Feinberg School of Medicine, said in her presentation. “There is also typically an activation of the body’s stress system.”
Researchers conducted a retrospective data analysis on a cohort of patients with GERD who underwent 96-hour wireless pH monitoring (n = 117). The primary outcome of the study was to evaluate the differences between positive acid exposure time (AET) and symptom-reflux association (SRA) using the esophageal hypervigilance and anxiety scale (EHAS). Patients also completed questionnaires to assess their symptom severity (GerdQ).
Investigators collected information on pH monitoring according to number of days (0, 1-2, 3-4) of positive AET (time pH < 4 greater than 6%), the number of days with positive SRA (symptom index > 50%). Over the course of pH monitoring, patients would record whenever they experienced GERD symptoms, and researchers compared those reports to acid levels recorded on the implanted chip used during monitoring.
Researchers found that EHAS scores were not different between the number of days of positive AET (29.4 vs. 33.5) or number of days with positive SRA (29.2 vs. 35.3). GerdQ scores were higher for the 3 to 4-day positive groups compared with the 0-day groups in both AET (P = .032) and SRA (P = .008).
Researchers found that that median self-reported symptom frequency was also different among the three AET (5 vs. 10 vs. 6; P = .042) and SRA (4 vs. 7 vs. 12; P < .001) groups.
Guadagnoli said their findings show that psychological processes are present across the GERD spectrum, whether or not patients had active acid exposure.
“Someone that is experiencing 4 straight days of abnormal acid exposure who is consistently experiencing frequent and sever symptoms might be at risk for developing some hypervigilance or even anxiety around those symptoms,” Guadagnoli said. “Just because someone has abnormal acid, doesn’t mean they are exempt from developing the psychological and behavioral processes that might be maintaining the symptoms even despite acid being there.” – by Alex Young
Guadagnoli L, et al. Abstract 270. Presented at: Digestive Disease Week; May 18-21, 2019; San Diego.
Disclosures: Guadagnoli reports no relevant financial disclosures. Please see the meeting disclosure index for all other authors’ relevant financial disclosures.