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J Med Sci 2021;41 (1):9‑16

DOI: 10.4103/jmedsci.jmedsci_51_20 ORIGINAL ARTICLE 

Association of Gastroesophageal Reflux Disease with Anxiety, Depression, and

Sleep Disorders

S. Shanmugapriya1, A. Saravanan2, S. Shuruthi3, J. Suriya Dharsini3, T. Saravanan2

Departments of 1Pharmacology, 2Medicine and 3 Department of Pharmacy Practice, PSG Institute of Medical Sciences and
Research, Coimbatore, Tamil Nadu, India

Background: Gastroesophageal reflux disease  (GERD) is commonly associated with impaired quality of life. Chronic
symptoms in this highly prevalent disorder could potentially lead to psychological manifestations such as anxiety, depression,
and sleep disorders. Aim: The purpose of the study was to evaluate the magnitude of association of GERD symptoms based on
health‑related quality of life (GERD‑HRQL) with anxiety, depression, and sleep quality using Hospital Anxiety and Depression
Scale (HADS) and Pittsburgh Sleep Quality Index (PSQI). Methods: This was a cross‑sectional study done at a tertiary care
hospital in 241 participants. Cases were patients diagnosed with GERD, and the control group was participants who did not
have GERD, devoid of all gastrointestinal symptoms according to GERD‑HRQL. Data on age, gender, body weight, smoking/
alcohol intake, and medication history were obtained from 98 cases and 143 matched control subjects. The three questionnaires,
namely, GERD‑HRQL, HADS, and PSQI questionnaires were administered by a trained blinded interviewer. Results: There
was a statistically significant difference (P < 0.001) in the mean score of cases in the HADS depression scale (7.35 ± 3.65); the
HADS anxiety scale (9.33 ± 4.51) and the mean global PSQI sleep score (4.62 ± 1.96) compared to the controls. Using Pearson’s
correlation, heart burn (P = 0.036), and regurgitation scores (P = 0.026), including the global quality of life score (P = 0.003),
correlated significantly with the anxiety score. We found a statistically significant correlation between heart burn and poor
sleep (P = 0.012) but not for regurgitation (P = 0.772). Conclusions: This study highlights the increased risk of anxiety,
depression, sleep disorder in GERD, and the significant correlation between HRQL, especially heartburn with anxiety and poor
sleep quality. This enlightens that specific screening and treatment strategies targeting such psychological manifestations are
imperative for overall improved quality of life in GERD patients.
Key words: Mood disorders, sleep quality, Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index, gastroesophageal
reflux disease‑health related quality of life

INTRODUCTION 11.6% in Australia, and 23.0% in South America.2 Although

Gastroesophageal reflux disease  (GERD) is a chronic
disorder characterized by reflux of the stomach contents,
which can give rise to symptoms and complications. Typical
GERD symptoms affect patients’ quality of life and overall
work productivity.1 In addition, it also contributes to enormous
health‑care costs. It is a highly prevalent disorder, and a recent
systematic review showed that the prevalence of GERD is
18.1%–27.8% in North America, 8.8%–25.9% in Europe,
2.5%–7.8% in East Asia, 8.7%–33.1% in the Middle East,
Received: March 09, 2020; Revised: April 12, 2020;
conventionally considered as a disease affecting middle age
and the older population, recent studies have shown that there
is a significant increase in the proportion of the disease in the
younger age group. 3
Patient’s quality of life is increasingly being considered
as a medical outcome index in the evaluation of the impact
of GERD symptoms on patients’ health status. The impact of
This is an open access journal, and articles are distributed under the terms of
the Creative Commons Attribution‑NonCommercial‑ShareAlike 4.0 License,
which allows others to remix, tweak, and build upon the work non‑commercially,
as long as appropriate credit is given and the new creations are licensed under
the identical terms.

Accepted: June 03, 2020; Published: July 25, 2020

For reprints contact: WKHLRPMedknow_reprints@wolterskluwer.com
Corresponding Author: Dr. S. Shanmugapriya, Department
of Pharmacology, PSG Institute of Medical Sciences and How to cite this article: Shanmugapriya S, Saravanan A, Shuruthi S,
Research, Off Avinashi Road, Peelamedu, Coimbatore Dharsini JS, Saravanan T. Association of gastroesophageal reflux
‑ 641 004, Tamil Nadu, India. Tel: 0422‑2570170‑5808; Fax: disease with anxiety, depression, and sleep disorders. J  Med Sci
2021;41:9-16.
0422-2594400. E‑mail: somasundaram999@rediffmail.com

© 2020 Journal of Medical Sciences | Published by Wolters Kluwer - Medknow 9

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Anxiety, depression, and sleep disorders in GERD
GERD on quality of life can be evaluated by a detailed symptom
analysis which typically includes heartburn, acid regurgitation
and epigastric pain in the majority of the patients using GERD
health‑related quality of life (HRQL) questionnaire.4
Studies have shown that chronic conditions like GERD could
secondarily result in psychological manifestations of anxiety,
depression, and insomnia. Few studies have also demonstrated
that anxiety and depression could decrease the threshold for
perception of visceral stimuli, thereby exacerbating the risk
of developing functional gastrointestinal (GI) disorders, thus
elucidating a bidirectional cause and effect relationship.5‑7
The current research focuses on the interplay between the
psychological manifestations of anxiety, depression, altered
sleep, and the symptomatology of GERD with the objective to
evaluate the magnitude of the correlation between the quality
of life and the psychological status of patients.
Literature evidence reveals that there is a paucity of studies
evaluating psychosocial impairment due to GERD symptoms
in the Indian population. Hence, this study was aimed to
evaluate the magnitude of association of GERD symptoms
with anxiety, depression and sleep quality by assessing the
correlation of the GERD‑HRQL scores with that of anxiety,
depression and sleep quality using the respective Hospital
Anxiety and Depression scale (HADS) and Pittsburgh Sleep
Quality Index (PSQI) scale in Indian patients with GERD.
In addition, the study was also designed to analyze whether
anxiety, depression, and sleep scores were affected by
comorbidities in GERD patients.
METHODS
This was a hospital‑based cross‑sectional questionnaire
study done at tertiary care teaching hospital after the approval by
PSG Institute of Medical Sciences and Research‑Institutional
Human Ethics Committee (Approval no: 16/435 dated January
10, 2017). Patients attending Gastroenterology and Medicine
outpatient department and diagnosed with GERD were included
for the study after obtaining written informed consent. GERD
was diagnosed based on the presence of the typical clinical
presentation along with the endoscopic features of GERD.
The control group were subjects who did not have GERD and
were devoid of all GI symptoms, according to GERD‑HRQL.
GERD‑HRQL questionnaire, a disease‑specific tool, was used
to measure the symptomatic outcomes and therapeutic effects
in patients with GERD. The scale had 16 items that focused on
heartburn symptoms, dysphagia, medication effects, and the
patient’s present health condition. Each item was scored from
0 to 5, with a higher score indicating a better quality of life.
Two scores, namely heartburn score and regurgitation score,
were obtained by the summation of the scores for questions
10
1–6 and 10–15 respectively in addition to the total score
derived by summing all the 15 score values. The 16th question
was a patient’s satisfaction question based on a 3 point scale.
Velanovich et al. had examined the psychometric properties
of the GERD‑HRQL in GERD patients and reported that the
Cronbach’s α coefficient for each subscale ranged from 0.89
to 0.94 demonstrating a high test– retest reliability and internal
consistency.4
The presence of anxiety and depression levels was assessed
using the Anxiety and Depression Scale. The HADS, a widely
used scale that had been designed for detecting depression
and anxiety in out‑patient clinic setting, was used to measure
symptoms of anxiety and depression and consisted of 14
items, seven items for the anxiety subscale, and seven for
the depression subscale. HADS Anxiety (HADS A) focused
on the symptoms of generalized anxiety disorder, and
HADS depression (HADS D) was focused on anhedonia,
the main symptom of depression. Each item was scored on a
response‑scale with four alternatives ranging between 0 and 3.
The overall score value 8 or higher was considered the cutoff
value for the existence of anxiety and depression.8
The PSQI, an effective instrument was used for measuring
the quality and patterns of sleep based on examination of
seven domains: subjective sleep quality, sleep latency, sleep
duration, habitual sleep efficiency, sleep disturbances, use
of sleep medication, and daytime dysfunction over the past
month. Scoring of responses ranged from 0 to 3, and all the
seven components were summed together with scores of 5 or
greater indicating poor sleep quality.9
The subjects included in this study were >20 years of age,
either newly diagnosed or on proton‑pump inhibitor (PPI)
therapy. Patients who had concomitant diabetes, hypertension,
liver, pancreatic, or chronic renal disease were also included in
the study. The participants included were either non-smokers
or those who were current or ex‑smokers with a smoking
index <100 and also non-alcoholic. However, patients who
had serious comorbidities such as liver failure, renal failure,
morbid obesity, patients with heart disease on antiplatelet
therapy, osteoporosis patients and those on long‑term
nonsteroidal anti‑inflammatory drugs  (NSAIDs) or other
chronic medications which cause gastric reflux and those with
documented history of psychiatric illnesses including anxiety
disorders, depression or bipolar illness and sleep disorders
were excluded. Subjects aged <20 years, pregnant and lactating
women were also excluded from the study.
A total of 98 cases by consecutive sampling were recruited
from January 2018 to May 2018. Data on age, gender, body
weight, alcohol intake, smoking, NSAID intake, concomitant
GI medications other than PPI, including their daily dose
were obtained. Similarly, data were also obtained from 143
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S. Shanmugapriya, et al.

control subjects who were matched so that they represented Table 1: Comparison of scores across age and gender
the same proportion of subjects with age, sex, and smoking groups using independent sample t-test
status as in the case group. The three questionnaires, Scale Age (years)/sex Mean SD t P*
namely, GERD‑HRQL, HADS, PSQI questionnaires, were score
administered by a trained interviewer blinded to the group to GERD-HRQL <50 24.24 11.92 0.472 0.638
which the participant belongs. ≥50 23.20 9.82
HADS D <50 6.88 3.47 1.399 0.165
Statistical analysis ≥50 7.93 3.81
All data were entered in excel, and the statistical analyses HADS A <50 9.72 4.20 0.921 0.359
were performed using SPSS version 24 (IBM Corporation,
≥50 8.86 4.87
United states). The mean HADS and PSQI scores of patients
PSQI <50 4.77 2.10 0.883 0.379
and controls were compared using an independent sample t‑test
to detect statistical significance. Similarly, Student’s t‑test was ≥50 4.43 1.77

also used to analyze if the mean difference in the scores of GERD-HRQL Male 23.56 10.68 0.268 0.790
the patients with and without comorbidities were significant. Female 24.21 11.76
In addition, the correlation of the GERD‑HRQL scores with HADS D Male 6.92 3.32 1.572 0.122
anxiety, depression, and sleep quality scores in patients with Female 8.25 4.17
GERD was performed using Pearson’s correlation. HADS A Male 8.66 4.26 2.067 0.043
Female 10.71 4.76
RESULTS
PSQI Male 4.46 2.05 1.175 0.244
Female 4.93 1.74
We recruited a total of 241 participants after obtaining
*P<0.05 is statistically significant. SD=Standard deviation;
written informed consent, among which 98 subjects were GERD=Gastroesophageal reflux disease; HRQL=Health-related quality
GERD patients and recruited to the case group, while the of life; HADS=Hospital anxiety and depression scale; HADS D=HADS
remaining 143 participants were the non‑GERD control depression; HADS A=HADS anxiety; PSQI=Pittsburgh sleep quality index
population. A total of 84 cases were on proton‑pump inhibitor
therapy, accounting for a percentage of 85.71%. The mean age Table 2: Comparison of depression, anxiety, and
of the cases was 46 years, whereas the mean age in the control sleep quality scores between cases and controls using
group was 50 years. Among the cases, 55.10% were <50 years independent sample t-test
of age and 44.90% were in the age group of 50 years and above. Scale Case/control Mean score SD t P*
Also, 67.35% cases were males and the rest were females with HADS D Case 7.35 3.65 5.934 <0.001
male: female ratio approximating 2:1. The analysis revealed Control 4.60 3.34
that there was no difference in the mean scores between the HADS A Case 9.33 3.51 5.387 <0.001
cases in the age group <50 years and those who were aged Control 6.35 3.74
50 years and above. Among the cases, an independent sample PSQI Case 4.62 1.96 5.076 <0.001
t‑test demonstrated that the mean score for anxiety was
Control 3.33 1.89
significantly higher in the female population compared to the
*Statistically significant. SD=Standard deviation; HADS D=Hospital
males among the cases, but no such significant difference was anxiety and depression scale depression; HADS A=HADS anxiety;
evident for the depression or the sleep score [Table 1]. PSQI=Pittsburgh sleep quality index
The mean score of the cases in the HADS D scale
(7.35 ± 3.65) was significantly higher (P < 0.001) compared disorder (45.91%) were significantly higher compared to the
to the mean score of the control population (4.60 ± 3.34) using control population [Table 3].
independent sample t‑test. Likewise, the mean anxiety score of Analysis of the GERD‑HRQL scores revealed that among
the cases (9.33 ± 4.51) was greater in comparison to the mean the 98 cases in the study population, 35 patients (35.7%)
score of the controls (6.35 ± 3.74) using HADS A, and this had symptomatic heartburn, whereas 45 patients (45.9%)
difference was also statistically significant (P < 0.001). A similar were symptomatic for regurgitation. On the satisfaction
significance in the PSQI sleep score between cases and controls scale, 66.35% were satisfied with their present condition and
was also obtained using Student’s t‑test [Table 2 and Figure 1]. 26.50% recorded a neutral response, while 7.15% were found
A Chi‑square test revealed that the proportion of cases found to be dissatisfied with their current clinical status [Figure 2].
to have depression (50%); anxiety (66.32%), and sleep A comparative analysis of whether the mean scores vary

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Anxiety, depression, and sleep disorders in GERD

12 Case
9.33
10 Control 7.15%
7.35
8 6.35
4.6 4.62 26.50% satisfied
6
3.33
4
neutral
2
dissatisfied
0
66.35%
HADS D score HADS A score PSQI score
Figure 1: Chart representing mean ± standard deviation of the scores between
cases and controls. The error bars represent standard deviation

Table 3: Comparison of the proportion of cases and Figure 2: Chart representing satisfaction score in Gastroesophageal Reflux
Disease‑Health Related Quality of life Scale
control with and without depression, anxiety and sleep
disturbances using Chi-square test
with depression score whilst there was a correlation of the
Depression Anxiety Sleep disorder
patient satisfaction with the depression score. However, both
Yes No Yes No Yes No
the heartburn and the regurgitation scores correlated with
Cases 49 49 65 33 45 53 the anxiety score, including the global quality of life score.
Controls 35 108 58 85 26 117 Interestingly, we found that there was a statistically significant
Chi-square statistic 16.684 15.449 21.526 correlation between heartburn and poor sleep, which was not
P* <0.001 <0.001 <0.001 detectable for regurgitation. In addition, it was found that the
*Statistically significant patients unsatisfied with their present clinical status were more
likely to have depression and poor sleep quality rather than
significantly among the patients with asymptomatic  (scores anxiety [Table 6 and Figure 3].
of  ≤12 with each individual question not exceeding 2 for
questions 1–6 of the GERD‑HRQL indicate heartburn DISCUSSION
elimination) and symptomatic heartburn with scores of >12,
it was found that the though the mean depression and anxiety A statistically higher mean score for all the three clinical
scores were higher in the symptomatic patients, there was conditions, namely depression, anxiety, and sleep disturbance
no statistical significance between the mean difference in was demonstrable in the GERD cases compared to the
the scores detectable. However, patients with symptomatic control group indicating a high risk of these psychological
heartburn had a statistically significant higher mean score for manifestations in patients with reflux disease. Conceivably,
sleep disturbance (P = 0.034) compared to the asymptomatic impairment in quality of life was also elicited in the cases
group. However, when a similar analysis was performed for compared to the control population using GERD‑HRQL.
the regurgitation, there was no significant mean difference Our study is one of the few studies evaluating the interplay
between those with scores >12 and those with lower scores in between the HRQL changes in GERD with the various
all the three scales [Table 4]. psychological manifestations such as anxiety, depression,
Comparison of the mean scores of the cases with and and sleep manifestations in a South Indian population.
without comorbidities, there was no statistical significance in Considering the cut off value of 8 for the diagnosis of anxiety
the mean scores obtained for those with and without diabetes, and depression using the respective components of the HADS
hypertensive and normotensive patients, those with other questionnaire, the study has effectively demonstrated that
comorbidities such as liver disease, pancreatic, or chronic a high probability of anxiety disorder existed in the GERD
renal disease [Table 5]. population with a mean anxiety score of 9.33 ± 3.51 unlike
Analyzing the correlation of heartburn, regurgitation and with respect to depression wherein the mean score was
satisfaction components of the quality of life scores with the marginally below the cut off value. A similar result was also
depression, anxiety and sleep quality scores, it was found that obtained in another study done in 225 patients by Kessing
neither the heartburn nor the regurgitation score correlated et al.10 However, our result was in contrast to a previous study

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S. Shanmugapriya, et al.

Table 4: Comparison of depression, anxiety, and sleep quality scores with gastroesophageal reflux disease-health related
quality of life scores of the cases
Scale Heart burn score ≤12 Heart burn score >12 Regurgitation score ≤12 Regurgitation score >12
HADS D 7.17±3.92 7.68±3.14 7.18±3.79 7.55±3.51
HADS A 8.85±4.42 10.20±4.61 8.96±3.98 9.77±5.08
PSQI 4.26±1.56* 5.25±2.41* 4.71±2.04 4.51±1.87
*P value significant at 0.05 level using independent sample t-test. HADS D=Hospital anxiety and depression scale depression; HADS A=HADS anxiety;
PSQI=Pittsburgh sleep quality index

Table 5: Comparison of depression, anxiety, and sleep quality scores of cases with and without comorbidities
Scale Comorbidities n Mean score SD t P*
HADS D With comorbidities 70 7.04 3.25 1.181 0.245
No comorbidities 28 8.14 4.47
Diabetes 22 8.68 3.83 1.872 0.070
No diabetes 76 6.97 3.53
Hypertension 17 8.64 4.66 1.310 0.205
No hypertension 81 7.08 3.37
Liver disease 35 7.65 2.74 0.674 0.502
No liver disease 63 7.19 4.08
Pancreatic and renal disease 36 7.52 4.32 0.325 0.746
No pancreatic and renal disease 62 7.25 3.23
HADS A With comorbidities 70 9.25 4.12 0.244 0.808
No comorbidities 28 9.53 5.44
Diabetes 22 9.40 5.34 0.075 0.941
No diabetes 76 9.31 4.28
Hypertension 17 9.58 5.88 0.203 0.842
No hypertension 81 9.28 4.21
Liver disease 35 9.48 4.27 0.249 0.804
No liver disease 63 9.25 4.67
Pancreatic and renal disease 36 10.02 4.99 1.105 0.273
No pancreatic and renal disease 62 8.93 4.20
PSQI With comorbidities 70 4.42 1.72 1.351 0.185
No comorbidities 28 5.10 2.42
Diabetes 22 5.00 2.48 0.856 0.399
No diabetes 76 4.51 1.78
Hypertension 17 5.11 2.20 1.042 0.309
No hypertension 81 4.51 1.90
Liver disease 35 4.57 2.01 0.189 0.851
No liver disease 63 4.65 1.94
Pancreatic and renal disease 36 4.66 1.92 0.171 0.865
Pancreatic and renal disease 62 4.59 1.99
*P<0.05 is significant. SD=Standard deviation; HADS D=Hospital anxiety and depression scale depression; HADS A=HADS anxiety; PSQI=Pittsburgh
sleep quality index

in which depression was found to be one of the most prevalent amongst which concomitance of liver diseases recorded the
comorbidities in patients with GERD.11 Our research revealed highest. However, none of the comorbidities were significantly
that a high proportion of cases (71.42%) had comorbidities associated with the HADS or the sleep scores.

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Anxiety, depression, and sleep disorders in GERD
Table 6: Correlation between gastroesophageal reflux disease-health related quality of life score with depression, anxiety,
and sleep quality scores of cases
Scale GERD-HRQL score Heart burn score
Pearson correlation P* Pearson correlation
HADS D score 0.157 0.122 0.071
HADS A score 0.293 0.003 0.212
PSQI score 0.161 0.113 0.252
*Correlation is significant if P<0.05 (two-tailed significance). GERD=Gastroesophageal reflux disease; HRQL=Health-related quality of life; HADS
D=Hospital anxiety and depression scale depression; HADS A=HADS anxiety; PSQI=Pittsburgh sleep quality index
Figure  3: Chart representing the correlation of Gastroesophageal Reflux
Disease‑Health Related Quality of Life score with depression, anxiety, and
sleep quality scores of cases. *Correlation coefficient r value is significant
Although the literature evidence strongly supports the
association of sleep disorder manifestations with GERD7,12 the
mean global PSQI score of cases in our study did not achieve
the significant cut-off level of 5 indicative of poor quality
sleep despite the mean score being significantly higher than
the control population. This could be potentially because a
large majority of patients (85.71%) were on treatment with
PPI. A systematic review has delineated that a statistically
significant improvement in sleep quality occurred after
initiation of PPI therapy in GERD patients though it may not
be completely successful in normalizing the sleep quality to
achieve a global PSQI score that is not statistically different
from the control population.13   The large proportion of cases
on PPI therapy precluded a between‑group analysis of the
depression, anxiety, and sleep scores with the patients not on
PPI in our research. Symptomatic relief with PPI therapy can
consequentially alleviate the psychological manifestations in
GERD though evidences support that persistent symptoms
despite PPI treatment is quite common which can impede the
improvement in severity of the psychological parameters.
Studies have supported that chronic and mild inflammation
in the GI tract due to GERD could result in up‑regulation
of the central nervous system (CNS) cytokine production
which in turn can affect the CNS functions, ultimately
resulting in psychiatric manifestations such as depressive
14
Regurgitation score Satisfaction score
P* Pearson correlation P* Pearson correlation P*
0.488 0.150 0.141 0.244 0.016
0.036 0.225 0.026 0.177 0.081
0.012 0.030 0.772 0.267 0.008
and anxiety disorders.14‑16 Studies in animal models have also
demonstrated that chronic peripheral inflammation induces
central pro‑inflammatory markers like interleukin IL-1β
as well as tumor necrosis factor alpha‑α;17 the long term
elevation of which significantly correlate with the occurrence
of psychological manifestations supporting the hypothesis.18
In addition, the symptom complex of GERD enables
envisioning the intertwined and bidirectional nature of the
relationship between sleep disorders and GERD. GERD results
in heartburn, acid reflux, sinusitis or sinus problems, and
frequent dry cough necessitating throat‑clearing that awakens
the patient during sleep. Frequent arousal during sleep activates
neuroendocrine systems, including the vagal nerve and triggers
bronchoconstriction. Frequent bronchoconstriction narrows
the diameter of the respiratory tract and arouses patients
from sleep, intensifying sleep disorders.19‑21 Furthermore,
GERD‑related micro‑aspirations inducing bronchial exudative
mucosal reaction also adds to the narrowing in diameter of the
respiratory tract, accelerating sleep disorder.22 The flip side of
the coin is that for several reasons, GERD symptoms aggravate
during sleep. Anti‑reflux mechanisms such as swallowing
rate, upper and lower esophageal sphincter pressure, gastric
emptying, and the awareness of heartburn have all been found
to be depressed during sleep. Also, while recumbent, the force
of gravity encourages the flow of gastric content towards
the esophagus. Thus, current literature supports the fact that
sleep disorder has a dual cause and effect relationship with
GERD.13,23
A differential effect of the two predominant symptoms,
namely heartburn and regurgitation analyzed using
GERD‑HRQL, illustrated that heartburn patients had a
significantly lower mean PSQI score and a positive correlation
with anxiety and poor sleep quality whilst regurgitation
only correlated with anxiety score. A similar result has
been documented by Lee et  al. whose study disclosed that
patients with heartburn had more severely impaired daily
activity, including sleep interruption compared to those with a
predominant regurgitation.24 Likewise, increased anxiety level
has been found to be associated with greater heartburn but
not regurgitation.10 This discrepancy perhaps stems from the
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differences in physico‑pathological mechanism underlying the
key clinical presentations of GERD. Reflux episodes inducing
regurgitation has been shown to have a higher proximal extent
of the liquid component, but less esophageal pH drop, than
episodes inducing heartburn.25
In the current study, a significant positive correlation
between the GERD‑HRQL and anxiety was demonstrable but
not for depression and sleep derangements. A similar study
using a different scale for evaluating depression, anxiety
and HRQL was able to prove that there existed a significant
correlation of the quality of life with both anxiety and
depression.26 The difference in results could be attributed to
the fact that our study was done in a smaller subset of patients
with GERD and that most patients were on treatment which
also precluded a between‑group analysis of untreated patients
with those on treatment. Furthermore, the categorization of
cases into the erosive and nonerosive disease was not done,
and these were our study limitations.
However, the study has clearly brought out the need to
understand the increased risk of psychological manifestations
including depression, anxiety, and sleep disorders in GERD
patients including those on treatment, which necessitates
addressal by periodic assessments and redressal by specific
planned psychiatric interventions, both pharmacological and
behavioral, as a part of the comprehensive treatment plan.
CONCLUSIONS
The study highlights that GERD patients constitute a
vulnerable population for psychological disturbances such
as anxiety, depression, and sleep disorder, which may not be
completely eliminated by the treatment of the underlying reflux
disease. Hence, periodic evaluation and specific treatment
strategies for such manifestations would be beneficial in
improving the quality of life in these patients.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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