Department of Surgery, Escola Paulista de Medicina, Rua Diogo de Faria 1087, cj 301, São Paulo, SP, 04037-003, Brazil.
Hospital São Luiz Morumbi, São Paulo, Brazil.
Surg Endosc. 2019 Dec;33(12):4116-4121. doi: 10.1007/s00464-019-06716-y. Epub 2019 Feb 27.
Symptoms may be unreliable to diagnose gastroesophageal reflux disease (GERD) in patients with minor psychiatric disorders (MPD). This study aims to evaluate the influence of MPD in the diagnosis of GERD.
We prospectively studied 245 patients (based on a sample size calculation) with suspected GERD. All patients underwent manometry and pH monitoring and MPD evaluation based on the Hospital Anxiety and Depression Scale (HADS).
Based on the results of the pH monitoring, patients were classified as GERD + (n = 136, 55% of the total, mean age 46 years, 47% females) or GERD - (n = 109, 45% of the total, mean age 43 years, 60% females). The mean HADS score for GERD + and GERD - for anxiety was 7.8 and 8.5, respectively (p = 0.8) and for depression was 5.4 and 6.1, respectively (p = 0.1). DeMeester score (DS) did not correlate with total HADS score (p = 0.08) or depression domain (p = 0.9) but there was a negative correlation between DS and anxiety level (p < 0.001). A significant threshold accuracy value for HADS to diagnose GERD was not found on receiver operating characteristics curve analysis.
Almost half of the patients evaluated for GERD did not have the disease on objective evaluation. GERD + and GERD - patients had similar levels of MPD. However, the amount of reflux correlated negatively with the severity of anxiety. Symptoms and HADS cannot accurately diagnose or exclude GERD. pH monitoring should be more liberally used especially in patients with high levels of anxiety.
在患有轻度精神障碍（MPD）的患者中，症状可能无法可靠地诊断胃食管反流病（GERD）。本研究旨在评估 MPD 对 GERD 诊断的影响。
我们前瞻性研究了 245 例疑似 GERD 的患者（基于样本量计算）。所有患者均接受了测压和 pH 监测，并根据医院焦虑和抑郁量表（HADS）进行了 MPD 评估。
根据 pH 监测结果，患者被分为 GERD+（n=136，占总数的 55%，平均年龄 46 岁，47%为女性）或 GERD-（n=109，占总数的 45%，平均年龄 43 岁，60%为女性）。GERD+和 GERD-的 HADS 焦虑评分均值分别为 7.8 和 8.5（p=0.8），抑郁评分均值分别为 5.4 和 6.1（p=0.1）。DeMeester 评分（DS）与总 HADS 评分（p=0.08）或抑郁域（p=0.9）均无相关性，但与焦虑水平呈负相关（p<0.001）。在接受者操作特征曲线分析中，未发现 HADS 诊断 GERD 的临界准确性值。
在接受 GERD 客观评估的患者中，近一半患者实际上并未患病。GERD+和 GERD-患者的 MPD 水平相似。然而，反流量与焦虑严重程度呈负相关。症状和 HADS 不能准确诊断或排除 GERD。pH 监测应更广泛地使用，尤其是在焦虑水平较高的患者中。
