J Neurogastroenterol Motil 2018; 24(4): 593-602  https://doi.org/10.5056/jnm18069
Association Between Anxiety and Depression and Gastroesophageal Reflux Disease: Results From a Large Cross-sectional Study
Ji Min Choi,1 Jong In Yang,1 Seung Joo Kang,1* Yoo Min Han,1 Jooyoung Lee,1 Changhyun Lee,1 Su Jin Chung,1 Dae Hyun Yoon,2 Boram Park,1 and Yong Sung Kim3
1Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea; 2Department of Psychiatry, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea; and 3Division of Gastroenterology, Department of Internal Medicine, Wonkwang University Sanbon Hospital, Gunpo, Gyeonggi-do, Korea
Correspondence to: Seung Joo Kang, MD
Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, GFC Building 152, Teheran Ro, Gangnam-gu, Seoul 06236, Korea
Tel: +82-2-2112-5772, Fax: +82-2-2112-5635, E-mail: ksjoo55@naver.com
Ji Min Choi and Jong In Yang contributed equally to this paper.
Received: April 6, 2018; Revised: June 18, 2018; Accepted: August 10, 2018; Published online: October 1, 2018.
© The Korean Society of Neurogastroenterology and Motility. All rights reserved.

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Abstract
Background/Aims
The different clinical manifestations of gastroesophageal reflux disease (GERD) may be influenced by associated psychological factors. We evaluated the psychological status (anxiety and depression) according to each subtype of GERD.
Methods
Subjects who underwent esophagogastroduodenoscopy and completed a symptom questionnaire between January 2008 and December 2011 were analyzed. The subjects were classified into the following groups: erosive reflux disease (ERD), non-erosive reflux disease (NERD), asymptomatic erosive esophagitis (AEE), and controls. Anxiety and depression were assessed using the State-Trait Anxiety Inventory and Beck Depression Inventory, respectively.
Results
We analyzed 19 099 subjects: 16 157 (84.6%), 176 (0.9%), 1398 (7.3%), and 1368 (7.2%) in the control, ERD, NERD, and AEE groups, respectively. Multiple multinomial logistic regression revealed a significant association of increased state (adjusted OR, 1.89; 95% CI, 1.53-2.33) and trait anxiety (adjusted OR, 1.78; 95% CI, 1.34-2.35) and depression (adjusted OR, 2.21; 95% CI, 1.75-2.80) with NERD. ERD group showed a significant association only with state anxiety (adjusted OR, 2.20; 95% CI, 1.27-3.81) and depression (adjusted OR, 2.23; 95% CI, 1.18-4.22). The AEE group, however, did not show any significant association with psychological factors.
Conclusion
This cross-sectional study revealed that anxiety and depression levels were significantly higher in subjects with GERD (notably in the NERD) than in controls.
Keywords: Anxiety; Depression; Gastroesophageal reflux; Psychology


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