title: Psychological distress is not associated with treatment failure in patients with gastroesophageal reflux disease.
abstract: OBJECTIVE
  Symptoms of anxiety and depression are common in patients with gastroesophageal reflux disease (GERD). We aim to examine the relationship between psychological distress and response to proton pump inhibitors (PPI).
  
  
  METHODS
  In this prospective study, GERD patients receiving PPI once or twice daily were divided into 3 groups: responders to PPI once daily (group A, N=111), non-responders to PPI once daily (group B, N=78) and non-responders to PPI twice daily (group C, N=56). All patients completed demographic and clinical questionnaires, Rome III Diagnostic Questionnaire for irritable bowel syndrome, Hospital Anxiety and Depression Scale (HADS), Satisfaction with Life Scale (SWLS) and the Gastroparesis Cardinal Symptom Index (GCSI) questionnaires.
  
  
  RESULTS
  A total of 245 patients (59.3% females, 52±17.2 years) participated in this study. No differences were observed between groups with respect to age, sex, psychiatric medications or pre-existing major depression. Anxiety (HADS-anxiety>7) was seen in 32%, 31% and 34% of groups A, B and C, respectively (p=ns). Depression (HADS-depression>7) was present in 30%, 31% and 21% of groups A, B and C, respectively (p=ns). Global satisfaction with life (SWLS>20) was present in 63% of group C patients, compared to 78% of group A and 78% of group B (p=0.04, p=0.05, respectively). GCSI scores (mean±SD) were 11.1±9.2, 14.07±8.5 and 16.3±10.4, for groups A, B and C, respectively (p=0.002). GCSI correlated significantly with HADS-anxiety (r=0.20, p=0.002) and SWLS (r=-0.2, p=0.01).
  
  
  CONCLUSIONS
  Lack of response to PPI was associated with lower life satisfaction but not anxiety or depression. Symptoms suggestive of gastroparesis were associated with anxiety and low satisfaction with life in patients with GERD.
authors.affiliation: Department of Gastroenterology, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel. Electronic address: dboltin@gmail.com.
authors.forename: Doron
authors.initials: D
authors.lastname: Boltin
authors.forename: Mona
authors.initials: M
authors.lastname: Boaz
authors.forename: Shoshana
authors.initials: S
authors.lastname: Aizic
authors.forename: Ami
authors.initials: A
authors.lastname: Sperber
authors.forename: Ronnie
authors.initials: R
authors.lastname: Fass
authors.forename: Yaron
authors.initials: Y
authors.lastname: Niv
authors.forename: Ram
authors.initials: R
authors.lastname: Dickman
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000209:etiology*; D003863:Depression / Q000209:etiology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000188:drug therapy* / Q000523:psychology*; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000523:psychology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000008:administration & dosage*; D013315:Stress, Psychological / Q000209:etiology*; D011795:Surveys and Questionnaires; D017211:Treatment Failure
chemical_list: D054328:Proton Pump Inhibitors
keywords: Anxiety; Depression; Functional gastrointestinal disease; Gastroesophageal reflux disease; Heartburn; Proton pump inhibitor