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The effect of psychological stress on symptom severity and perception in patients with gastro-oesophageal reflux.

Abstract

OBJECTIVE

Using an experimental paradigm this investigation explored whether exposure to psychological stress would produce a significant increase in acid-reflux episodes or modify subjective perceptions of gastro-oesophageal reflux (GOR) symptoms.

METHODS

Forty-two patients presenting with heartburn and acid regurgitation underwent 24-h oesophageal pH monitoring. During the last 90 min of this monitoring period, 21 patients received a psychological stressor, while the remaining participants were randomly assigned to a no-stress control condition. State anxiety and subjective GOR symptom ratings were obtained 1 min pretest, 1 min posttest, and 40 min posttest. Cortisol samples were collected at 10-min intervals.

RESULTS

The stressor induced a significant increase in cortisol and state anxiety; however, this was not associated with any increase in reflux. Instead, the experimental group reported a dissociation between objectively measured reflux episodes and subjective symptom ratings. A similar pattern was established for participants who reported greater state anxiety, produced larger cortisol responses, or exhibited certain stress-related personality characteristics.

CONCLUSION

The perception of symptoms in the absence of increased reflux when one is stressed may account for low response rates to traditional treatments. This highlights a need to bridge the gap between psychosomatic research and clinical practice to develop more successful GOR therapies.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Department of General Surgery, St. Thomas' Hospital, United Kingdom. c.e.wright@ucl.ac.uk

    , , ,

    Source

    Journal of psychosomatic research 59:6 2005 Dec pg 415-24

    MeSH

    Adult
    Aged
    Anxiety
    Attitude to Health
    Female
    Gastroesophageal Reflux
    Humans
    Hydrocortisone
    Hydrogen-Ion Concentration
    Male
    Middle Aged
    Prevalence
    Psychology
    Saliva
    Severity of Illness Index
    Stress, Psychological
    Surveys and Questionnaires

    Pub Type(s)

    Journal Article
    Randomized Controlled Trial

    Language

    eng

    PubMed ID

    16310024

    Citation

    Wright, Caroline E., et al. "The Effect of Psychological Stress On Symptom Severity and Perception in Patients With Gastro-oesophageal Reflux." Journal of Psychosomatic Research, vol. 59, no. 6, 2005, pp. 415-24.
    Wright CE, Ebrecht M, Mitchell R, et al. The effect of psychological stress on symptom severity and perception in patients with gastro-oesophageal reflux. J Psychosom Res. 2005;59(6):415-24.
    Wright, C. E., Ebrecht, M., Mitchell, R., Anggiansah, A., & Weinman, J. (2005). The effect of psychological stress on symptom severity and perception in patients with gastro-oesophageal reflux. Journal of Psychosomatic Research, 59(6), pp. 415-24.
    Wright CE, et al. The Effect of Psychological Stress On Symptom Severity and Perception in Patients With Gastro-oesophageal Reflux. J Psychosom Res. 2005;59(6):415-24. PubMed PMID: 16310024.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - The effect of psychological stress on symptom severity and perception in patients with gastro-oesophageal reflux. AU - Wright,Caroline E, AU - Ebrecht,Marcel, AU - Mitchell,Rebecca, AU - Anggiansah,Angela, AU - Weinman,John, PY - 2004/08/16/received PY - 2005/05/10/accepted PY - 2005/11/29/pubmed PY - 2006/3/24/medline PY - 2005/11/29/entrez SP - 415 EP - 24 JF - Journal of psychosomatic research JO - J Psychosom Res VL - 59 IS - 6 N2 - OBJECTIVE: Using an experimental paradigm this investigation explored whether exposure to psychological stress would produce a significant increase in acid-reflux episodes or modify subjective perceptions of gastro-oesophageal reflux (GOR) symptoms. METHODS: Forty-two patients presenting with heartburn and acid regurgitation underwent 24-h oesophageal pH monitoring. During the last 90 min of this monitoring period, 21 patients received a psychological stressor, while the remaining participants were randomly assigned to a no-stress control condition. State anxiety and subjective GOR symptom ratings were obtained 1 min pretest, 1 min posttest, and 40 min posttest. Cortisol samples were collected at 10-min intervals. RESULTS: The stressor induced a significant increase in cortisol and state anxiety; however, this was not associated with any increase in reflux. Instead, the experimental group reported a dissociation between objectively measured reflux episodes and subjective symptom ratings. A similar pattern was established for participants who reported greater state anxiety, produced larger cortisol responses, or exhibited certain stress-related personality characteristics. CONCLUSION: The perception of symptoms in the absence of increased reflux when one is stressed may account for low response rates to traditional treatments. This highlights a need to bridge the gap between psychosomatic research and clinical practice to develop more successful GOR therapies. SN - 0022-3999 UR - https://www.unboundmedicine.com/medline/citation/16310024/The_effect_of_psychological_stress_on_symptom_severity_and_perception_in_patients_with_gastro_oesophageal_reflux_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-3999(05)00208-4 DB - PRIME DP - Unbound Medicine ER -