Anxiety and depression reduce efficacy of PPIs among patients of GERD, functional dyspepsia

JAPAN: According to a study that was published in the journal Esophagus, anxiety and depression state decreased the therapeutic impact of proton pump inhibitors on gastroesophageal reflux disease and functional dyspepsia symptoms.

Although it is believed that the presence of anxiety and depression is associated to the symptoms of functional dyspepsia (FD) and gastroesophageal reflux disease (GERD), the cause-and-effect links between these conditions are not always clear.

The authors sought to investigate the long-term reciprocal causal relationship between anxiety/depression status and GERD/FD symptoms in symptomatic adult GERD patients.

Adult GERD patients, 20 years and above, got PPI medication for 4 weeks following endoscopy in order to achieve this goal. With the help of the gastroesophageal reflux and dyspepsia therapy efficacy and satisfaction test, GERD and FD symptom subscales (GERD-SS/FD-SS) were assessed (GERD-TEST). The hospital anxiety and depression scale were used to assess the severity of anxiety and depression (HADS). The causal associations between psychiatric bias (anxiety and depression ratings) and upper gastrointestinal symptoms (GERD-SS and FD-SS scores) over time were investigated using a cross-lagged analysis employing structural equation modeling. 182 individuals with GERD in total were eligible before (T1) and after (T2) 4 weeks of PPI medication (men: 120; age: 57.1 12.8 years; body mass index: 24.2 4.1 kg/m2; nonerosive reflux disease/erosive reflux disease: 61/121).

The authors reported that according to the cross-lagged effect model, anxiety at T1 contributed to the FD-SS at T2 (β = 0.18*), and depression at T1 contributed to the GERD-SS at T2 (β = 0.23*) (*p < 0.05).

Moreover, refractory GERD and FD were at risk due to psychiatric predisposition.

They concluded that in order to effectively treat patients and get the best therapeutic results, it is important to identify the anxiety/depression status of those who exhibit GERD/FD symptoms.

REFERENCE

Nakada, K., Oshio, A., Matsuhashi, N. et al. Causal effect of anxiety and depression status on the symptoms of gastroesophageal reflux disease and functional dyspepsia during proton pump inhibitor therapy. Esophagus (2022). https://doi.org/10.1007/s10388-022-00960-3