Study on the quality of life and psychological factors of 159 patients with different subtypes of refractory gastroesophageal reflux disease / 中华消化杂志

ABSTRACT

Objective:To explore the quality of life and psychological factors of patients with refractory gastroesophageal reflux disease (rGERD).Methods:From September 2016 to March 2019, 159 rGERD patients visiting the Department of Gastroenterology, Beijing Tongren Hospital Affiliated to Capital Medical University were retrospectively selected. According to the presence or absence of distal esophageal mucosal injury under gastroscopy, the patients were divided into refractory reflux esophagitis (RE) group (58 cases) and refractory non-erosive reflux disease (NERD) group (101 cases). The general data, the results of 24 h esophageal impedance pH, esophageal high-resolution manometry (HRM) and the scores of gatroesophageal reflux disease-questionnaire (GerdQ), 36-item short-form health survey (SF-36), self-rating anxiety scale(SAS) and self-rating depression scale (SDS) were recorded and compared between the two groups. Independent sample t test, rank sum test, chi-square test and multiple linear regression analysis were used for statistical analysis. Results:There were no significant differences in gender, age, abdominal circumference or body mass index between the two groups (all P>0.05). The incidence of extraesophageal symptoms of refractory NERD group was higher than that of refractory RE group (45.5%, 46/101 vs. 24.1%, 14/58), and the difference was statistically significant ( χ2=7.185, P=0.010). The episodes of gas reflux, weak-acid reflux and non-acid reflux were all more than those of refractory RE group (66.20 times, 45.20 times to 111.60 times vs. 38.40 times, 23.50 times to 59.63 times; 34.70 times, 9.05 times to 52.75 times vs. 6.35 times, 3.10 times to 24.00 times; 12.60 times, 2.15 times to 24.20 times vs. 2.15 times, 0 times to 10.30 times), GerdQ score of refractory NERD group was higher than that of refractory RE group (8.9±2.5 vs. 7.8±2.3), and DeMeester score, the symptom index and symptom association probability of refractory NERD group were all lower than those of refractory RE group (5.16, 1.75 to 14.48 vs. 15.19, 2.78 to 45.96; 33.3%, 0 to 60.0% vs. 57.5%, 40.5% to 78.0%; 87.8%, 0 to 97.8% vs. 94.0%, 82.7% to 98.2%); and the differences were statistically significant ( Z=-5.548, -5.384 and -4.338, t=3.306, Z=-2.607, -4.313 and -2.468; all P<0.05). The esophageal distal contractile integral of refractory NERD group was lower than that of refractory RE group (334.0 mmHg·s·cm, 182.5 mmHg·s·cm to 492.0 mmHg·s·cm vs. 399.0 mmHg·s·cm, 216.5 mmHg·s·cm to 756.3 mmHg·s·cm, 1 mmHg=0.133 kPa), and the difference was statistically significant ( Z=-2.204, P=0.030). There were no significant differences in lower escophageal sphincter or the length of peristaltic interruption between the two groups (both P>0.05). There were no significant differences in physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, mental health or reported health transition of SF-36 score between refractory NERD group and refractory RE group (all P>0.05). Among 159 patients with rGERD, 98 patients (61.6%) had anxiety and 55 patients (34.6%) had depression. The SAS score of refractory NERD group was higher than that of refractory RE Group (52.6±5.8 vs. 47.0±8.8), and the difference was statistically significant ( t=4.794, P<0.05), however there was no significant difference in SDS score between the two groups ( P>0.05). The results of multiple linear regression analysis showed that GerdQ score in rGERD patients was positively correlated with DeMeester score, gas reflux, weak acid reflux, SAS score and SDS score ( r=0.201, 0.228, 0.171, 0.229 and 0.276; all P<0.05). Conclusions:Among the patients with rGERD, the reflux symptoms are more severe in refractory NERD patients, which may be related to non-acid reflux, gas reflux, esophageal motor disorders, and psychological abnormalities, especially anxiety.