Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Am J Gastroenterol. 2023 Dec 1;118(12):2133-2143. doi: 10.14309/ajg.0000000000002411. Epub 2023 Jul 19.
An association between gastroesophageal reflux disease (GERD) and common psychiatric conditions, most notably anxiety and depression, has been reported. However, the magnitude of this association is poorly understood. Therefore, we aimed to systematically assess this issue.
We comprehensively searched multiple bibliographic databases (Embase, PubMed, Scopus, and Web of Science) from inception to May 15, 2023. We retrieved observational studies that reported the prevalence of anxiety and/or depressive symptoms diagnosed by validated questionnaires in ≥100 adults (aged 18 years or older) with GERD. We also included cohort studies that explored the risk of incident GERD in subjects with anxiety/depression vice versa scenario. Finally, we included Mendelian randomization studies that assessed the cause-and-effect relationship between anxiety/depression and GERD. The extracted data were combined using a random-effects model.
In total, 36 eligible studies were included. The pooled prevalences of anxiety and depressive symptoms were 34.4% (95% confidence interval [CI] 24.7-44.2; I2 = 99.4%) and 24.2% (95% CI 19.9-28.5; I2 = 98.8%) in subjects with GERD based on 30 studies, respectively. Both anxiety and depressive symptoms were more common in subjects with GERD compared with those in healthy controls (odds ratio = 4.46 [95% CI 1.94-10.25] and odds ratio = 2.56 [95% CI 1.11-5.87], respectively). According to 3 cohort studies, subjects with GERD were at an increased risk of developing anxiety/depression and vice versa. Finally, 3 Mendelian randomization studies showed that genetic liability to these mood disorders is linked to an increased risk of developing GERD and vice versa.
Up to 1 in 3 subjects with GERD experience anxiety and depression. There is likely a bidirectional causal relationship between anxiety/depression and GERD.
胃食管反流病（GERD）与常见的精神疾病之间存在关联，尤其是焦虑和抑郁。然而，这种关联的程度尚不清楚。因此，我们旨在系统地评估这个问题。
我们全面检索了多个文献数据库（Embase、PubMed、Scopus 和 Web of Science），检索时间从建库至 2023 年 5 月 15 日。我们检索了≥100 例成人（年龄 18 岁或以上）GERD 患者接受经过验证的问卷诊断为焦虑和/或抑郁症状的患病率的观察性研究。我们还纳入了探讨焦虑/抑郁患者中 GERD 发生率的队列研究，以及反之亦然的研究。最后，我们纳入了评估焦虑/抑郁与 GERD 之间因果关系的孟德尔随机研究。提取的数据采用随机效应模型进行合并。
共有 36 项符合条件的研究纳入。根据 30 项研究，GERD 患者的焦虑和抑郁症状的总患病率分别为 34.4%（95%置信区间[CI] 24.7-44.2；I2 = 99.4%）和 24.2%（95% CI 19.9-28.5；I2 = 98.8%）。与健康对照组相比，GERD 患者的焦虑和抑郁症状更为常见（比值比=4.46[95% CI 1.94-10.25]和比值比=2.56[95% CI 1.11-5.87]）。根据 3 项队列研究，GERD 患者发生焦虑/抑郁的风险增加，反之亦然。最后，3 项孟德尔随机研究表明，这些情绪障碍的遗传易感性与 GERD 风险增加有关，反之亦然。
多达 1/3 的 GERD 患者经历焦虑和抑郁。焦虑/抑郁与 GERD 之间可能存在双向因果关系。
