Heartburn symptoms tied to psychological factors in some patients

 

Heartburn sufferers who don’t feel better with standard treatment, but who have no detectable reflux, tend to have greater distress and worse quality of life, according to a new study.

In contrast, symptoms in patients with confirmed gastroesophageal reflux disease (GERD) that didn’t respond to acid-suppressing drugs were associated with reflux severity, Dr Rena Yadlapati of the University of Colorado Anschutz Medical Campus in Aurora and her colleagues found.

“Our results support the interplay between psychosocial factors and symptom generation for PPI non-responders with normal physiology,” the researchers write in American Journal of Gastroenterology.

These results are important in understanding various types of PPI non-responders and formulating personalized management strategies, they add.

As many as half of people with symptoms of reflux don’t get better with proton pump inhibitors (PPIs), the researchers note. To better understand how patients who don’t respond to PPIs perceive their symptoms, they tested esophageal function in 192 patients who had persistent heartburn despite being on double-doses of the medications for at least eight weeks.

Among the 125 patients who underwent testing while on PPIs, 58 percent were classified as having functional disease, meaning that testing found no evidence of esophageal dysfunction or reflux despite patients perceiving symptoms.

Another 34 percent were diagnosed with GERD because acid levels and other tests did indicate dysfunction in addition to the reported symptoms. Nine percent had reflux hypersensitivity, meaning the esophagus is extra sensitive to even slight reflux.

Among the 67 patients tested while off PPIs, 58 percent were found to have functional disease, 24 percent had GERD and 18 percent had reflux hypersensitivity.

For people with functional disease but no GERD diagnosis, the more severe the perceived symptoms the greater was their distress and difficulty swallowing. Their quality of life was also worse. However, their symptoms did not track with the physiological data from diagnostic testing for GERD.

In patients with confirmed GERD, symptom severity was tied to the number of reflux-associated symptoms and physiological measures of reflux, but it was not linked to psychosocial stressors or quality of life impairment.

“These results underscore the importance of reassurance, psychosocial support, and coping mechanisms” when treating patients with functional heartburn, the researchers write.

The findings also support the idea that functional heartburn and functional difficulty swallowing, known as dysphagia, “exist on the same reflux spectrum,” they add, so non-drug treatments for dysphagia such as eating upright and chewing carefully could be recommended.

For patients with GERD that does not respond to PPI, the researchers write, “antireflux management strategies, such as increased acid suppression, reflux inhibition, and restoration of the antireflux barrier, are appropriate treatment considerations.”

Dr Yadlapati was not available for an interview by press time.