Esophageal Hypervigilance and Mucosal Integrity Predict Symptom Outcomes in Reflux Patients With Normal Acid Exposure

Area of Science:

• Gastroenterology
• Psychosomatic Medicine

Background:

• Managing esophageal symptoms with normal acid exposure is challenging, necessitating focus on physiological and psychological factors.
• Few studies have explored patient perceptions of symptom changes with alginates or proton-pump inhibitors (PPIs) in this context.
• This study investigates symptom changes, esophageal hypervigilance, and psychological distress in patients with normal acid exposure treated with alginates or PPIs.

Purpose of the Study:

• To examine the interrelationships among changes in reflux symptom severity, esophageal hypervigilance, and psychological distress.
• To evaluate symptom changes and predictors between alginate suspension and PPI treatments in patients with normal esophageal acid exposure.

Main Methods:

• A 2-year prospective, randomized, open-label study involving 146 patients with normal acid exposure confirmed by pH-impedance monitoring.
• Participants completed validated questionnaires on esophageal hypervigilance and anxiety (EHAS), symptom severity, sleep quality, and depression at baseline and follow-up.
• Analysis included evaluating symptom changes and predictors between alginate and PPI treatment groups.

Main Results:

• Significant improvements in questionnaire scores were observed in both alginate and PPI groups (p < 0.001), with no intergroup differences.
• Few patients achieved >50% reduction in GERDQ and GSS scores with either treatment.
• Reduced esophageal hypervigilance and lower mean nocturnal baseline impedance (MNBI) were significant predictors of symptom improvement.

Conclusions:

• Neither PPIs nor alginates alone effectively improved symptoms in reflux patients with normal acid exposure.
• Reducing esophageal hypervigilance and anxiety significantly improved outcomes, independent of treatment type.
• Esophageal hypervigilance and anxiety scores are key predictors of treatment response, highlighting the need for a comprehensive approach addressing both psychological and physiological factors.