title: The effect of psychological stress on symptom severity and perception in patients with gastro-oesophageal reflux.
abstract: OBJECTIVE
  Using an experimental paradigm this investigation explored whether exposure to psychological stress would produce a significant increase in acid-reflux episodes or modify subjective perceptions of gastro-oesophageal reflux (GOR) symptoms.
  
  
  METHODS
  Forty-two patients presenting with heartburn and acid regurgitation underwent 24-h oesophageal pH monitoring. During the last 90 min of this monitoring period, 21 patients received a psychological stressor, while the remaining participants were randomly assigned to a no-stress control condition. State anxiety and subjective GOR symptom ratings were obtained 1 min pretest, 1 min posttest, and 40 min posttest. Cortisol samples were collected at 10-min intervals.
  
  
  RESULTS
  The stressor induced a significant increase in cortisol and state anxiety; however, this was not associated with any increase in reflux. Instead, the experimental group reported a dissociation between objectively measured reflux episodes and subjective symptom ratings. A similar pattern was established for participants who reported greater state anxiety, produced larger cortisol responses, or exhibited certain stress-related personality characteristics.
  
  
  CONCLUSIONS
  The perception of symptoms in the absence of increased reflux when one is stressed may account for low response rates to traditional treatments. This highlights a need to bridge the gap between psychosomatic research and clinical practice to develop more successful GOR therapies.
authors.affiliation: Department of General Surgery, St. Thomas' Hospital, United Kingdom. c.e.wright@ucl.ac.uk
authors.forename: Caroline E
authors.initials: CE
authors.lastname: Wright
authors.forename: Marcel
authors.initials: M
authors.lastname: Ebrecht
authors.forename: Rebecca
authors.initials: R
authors.lastname: Mitchell
authors.forename: Angela
authors.initials: A
authors.lastname: Anggiansah
authors.forename: John
authors.initials: J
authors.lastname: Weinman
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000503:physiopathology*; D001294:Attitude to Health; D005260:Female; D005764:Gastroesophageal Reflux / Q000503:physiopathology* / Q000523:psychology*; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011584:Psychology; D012463:Saliva / Q000737:chemistry; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000503:physiopathology*; D011795:Surveys and Questionnaires
chemical_list: D006854:Hydrocortisone