M. McNally1, P. Belle1, A. D. Jalilvand1, K. A. Perry1 1The Ohio State Wexner Medical Center,Division Of General And Gastrointestinal Surgery,Columbus, OH, USA
Introduction: Recognition and treatment of gastroesophageal reflux disease (GERD) is largely dependent on self-reported symptoms and quality of life assessment. Underlying psychiatric diagnoses and associated therapies may alter this presentation. As such, the primary goal of this study is to determine if baseline psychotropic medications impact the presentation of GERD, while secondary objectives included comparing disease-specific quality of life and symptom scales.
Methods: All patients who presented for elective surgical management of GERD from 2011 to 2016 at a single academic institution (n=359) were reviewed. Demographic data, presenting symptoms, objective work-up, and baseline scores on the gastro-esophageal reflux symptom scale (GERSS) and quality of life (GERD-HRQL) were obtained through chart review. Patients were grouped based on baseline (at the time of intake evaluation) usage of either a serotonin-modulating medication (SMM) or benzodiazepine (BZM) medication, as a proxy for major depression and anxiety disorders. Differences in presenting symptoms, GERSS and GERD-HRQL scores were carried out using Mann-Whitney U, Chi2, or Fisher’s Exact, as appropriate; a p value of <0.05 was considered statistically significant.
Results: One hundred and sixty-three patients (45.3%) were on psychotropic medications; SMM use accounted for 80% (n=131), followed by BZM (24%, n=62), and 19% were utilizing both SMM/BZM (n=31). Compared to those not on any psychotropic medications, patients on SMM experienced significantly higher rates of chest pain (29% vs 19%, p=0.03), had higher GERD-HRQL scores for dysphagia (3 (1-4) vs 2(0-4), p=0.03) and bloating (4 (2-5) vs 3 (2-4), p=0.05) Patients on BZM presented more often with regurgitation (77 % vs 55%, p <0.005) and trended towards more chest pain (29% vs 19%, p=0.09), while also scoring significantly worse on the GERD-HRQL (33 (25-41) vs 29 (19-36), p=0.02) and GERSS (45.5 (31-54) vs 38 (22-50), p=0.02). Similarly, patients on SMM/BZM also demonstrated higher rates of regurgitation (81% vs 52%,p=0.003) and scores significantly worse on GERD-HRQL (38 (28-43) vs 29 (19-36), p=0.004) and GERSS (48 (31-63) vs 38 (22-50), p=0.02). Compared to the control group, patients on SMM, BZM, or both SMM/BZM demonstrated no difference in motility or pH testing.
Conclusion: Patients on SMM or BZM who present with GERD have higher rates of regurgitation and chest pain and worse scores on disease specific quality of life and symptom scales, Further studies are needed to evaluate how these medications and their associated psychiatric diagnoses impact outcomes after antireflux surgery.