背景:胃食管反流病(GERD)影响很大比例的个体,生活压力是一个促成因素。本研究旨在探讨心身评估之间的相关性,心率变异性(HRV),一组个体中的GERD。此外,本研究旨在分析质子泵抑制剂(PPI)治疗后的测序变化,并确定与难治性GERD相关的预测因素.
方法:纳入105例反流性食管炎患者和50例无酸反流症状的对照组。心身评估,包括GERDQ,GERDQLQ,RSI,BAI,BDI,在基线和治疗期间评估SSS-8。还评估了HRV参数。多因素分析用于确定难治性GERD的预测因素。PPI在最初的2个月内定期给药,然后按需使用。难治性GERD定义为PPI治疗8周后症状缓解或GERDQLQ评分≥20改善小于50%。
结果:与对照组相比,GERD组在所有心身评估中的得分均较高(所有p值<0.001)。GERD组治疗前后HRV各项参数均无明显变化。在GERD症状和心理评分之间观察到强烈且一致的相关性(BAI,BDI,和SSS-8)跨越所有时间点(W0、W4和W8)。在治疗的最初八周期间观察到GERD症状评分和心身评估的顺序降低。较高的GERDQ(≥10)和SSS-8(≥12)评分可预测难治性GERD(分别为p=0.004和p=0.009)。
结论:本研究强调在治疗GERD时考虑生理和心理因素的重要性。心身评估为评估和治疗GERD患者提供了有价值的见解。将压力管理和综合评估整合到个性化治疗策略中至关重要。
BACKGROUND: Gastroesophageal reflux disease (GERD) affects a significant proportion of individuals, with life stress being a contributing factor. This study aimed to investigate the correlation between psychosomatic evaluations, heart rate variability (HRV), and GERD in a cohort of individuals. Additionally, the study aimed to analyze the sequencing changes following proton pump inhibitor (PPI) treatment and identify predictive factors associated with refractory GERD.
METHODS: A prospective cohort of 105 individuals with reflux esophagitis and a control group of 50 participants without acid reflux symptoms were enrolled. Psychosomatic evaluations, including GERDQ, GERDQLQ, RSI, BAI, BDI, and SSS-8, were assessed at baseline and during treatment. HRV parameters were also evaluated. Multivariate analysis was used to identify predictive factors for refractory GERD. PPIs were administered regularly for the initial 2 months and then used on-demand. Refractory GERD was defined as less than 50% improvement in symptom relief or GERDQLQ score ≥ 20 after 8 weeks of PPI treatment.
RESULTS: The GERD group had higher scores in all psychosomatic evaluations compared to the control group (all p-values < 0.001). There were no significant changes in any parameters of HRV before and after treatment in the GERD group. Strong and consistent correlations were observed between GERD symptoms and psychological scores (BAI, BDI, and SSS-8) across all time points (W0, W4, and W8). Sequential reductions in GERD symptom scores and psychosomatic evaluations were observed during the initial eight weeks of treatment. Higher GERDQ (≥10) and SSS-8 (≥12) scores were predictive of refractory GERD (p = 0.004 and p = 0.009, respectively).
CONCLUSIONS: This study emphasizes the importance of considering physiological and psychological factors in the management of GERD. Psychosomatic evaluations provide valuable insights for assessing and treating GERD patients. Integrating stress management and comprehensive assessments into personalized treatment strategies is crucial.