Analysis Of Psychological Characteristics Of Refractory GERD Patients With Different Subtypes And Reflux Types

Objective:To explore the psychological characteristics of rGERD patients with different subtypes and different reflux types,and develop effective treatment strategies for clinicians.Methods:Clinical data of 182 rGERD patients in department of gastricenterology of Anhui Provincial Hospital from January 2017 to October 2019 were collected.Esophageal high resolution manometry(HRM)and 24h-pH monitoring were performed in all patients,and their psychological characteristics by HAMA and HAMD scores,their quality of life by GERD-HRQL scores were recorded and evaluated.According to the results of 24 hours pH-impedance monitoring,they were divided into acid reflux-prodominant(AR)group,weak acid reflux-prodominant(WAR)group and non-acid reflux-prodominant(NAR)group.According to their clinical manifestations and pathologic results,they were divided into reflux esophagitis group(RE),non erosive reflux disease group(NERD)and Barrett esophagus group(BE).Results:(1)There were not obvious differences among the age,gender,BMI and health-related quality of life(HRQL)of refractory GERD patients with different subtypes and reflux types(P>0.05).However,the duration from disease onset to admission were different among the three groups(H=7.002,P=0.03).The course of disease was shorter in the WAR group.(2)The difference in Demeester scores among the three groups was statistically significant(H=40.253,P<0.001),and there were differences in Demeester scores between the AR group and the WAR group and between AR group and the NAR group(adjusted P<0.05).(3)Compared with AR group and NAR group,the incidence of anxiety in the WAR group was definitely statistically significant(?~2=11.913,P=0.001;?~2=12.270,P=0.005).(4)The incidence of anxiety was not statistically significant in AR group and NAR group(?~2=0.272,P=0.602),while the incidence of depression was statistically significant(?~2=6.121,P=0.013).(5)The HAMA and HAMD differences among the RE group,NERD group and BE group were statistically different(F=7.465,P<0.05);F=6.985,P<0.05),indicating that patients in the NERD group had higher scores of HAMA and HAMD than those in the RE and BE group.(6)The difference among the percentage of the three types of reflux in patients in RE group and NERD group was statistically significant(?~2=11.981,Pacid=0.001;?~2=32.242,Pweak-acid<0.001;?~2=11.902,Punacid=0.001).The differences between the percentages of acid reflux and weak acid reflux in the NERD group and the BE group were statistically significant(?~2=10.611,Pacid=0.001;?~2=8.789,Pweak-acid=0.003).The difference among the three groups of patients with pathological reflux was not statistically significant(P=0.503),which means that the NERD group had the lowest percentage of acid reflux and the weakest acid reflux had the highest percentage,and the difference between the other two groups is statistically significant(P<0.05).Conclusion:1.Patients with predominantly weak acid reflux are more likely to have anxiety and have a relatively short course of disease.2.NERD patients are more prone to weak acid reflux than RE and BE patients,and RE patients are more prone to non-acid reflux than NERD patients.3.NERD patients are more likely to have anxiety and depression symptoms than RE and BE patients.4.Weak acid/non-acid reflux may be one of the pathogenesis of rGERD.