Association Between Psychological Burden and Unexplained High Upper Esophageal Sphincter Basal Pressure

Proximal esophageal dysmotility and high psychological burden are common in individuals with esophageal or laryngopharyngeal reflux symptoms. However, the clinical significance of abnormal proximal motility remains unclear. Given that proximal esophagus consists of skeletal muscle, proximal esophageal motility may be influenced by psychological burden. This study aims to explore the relationship between psychological burden and proximal esophageal motility.

Patients with esophageal or laryngopharyngeal reflux symptoms were retrospectively included. Esophageal hypervigilance and anxiety scale (EHAS) was used to evaluate the psychological burden in patients. Demographics, endoscopic findings, proximal and distal esophageal manometric parameters, and reflux burden were compared between patients with and without esophageal hypervigilance and anxiety. Multivariate logistic regression analysis was conducted to determine the relationship between psychological burden and proximal esophageal motility.

A total of 341 subjects were enrolled. A greater proportion of patients with high EHAS had elevated upper esophageal sphincter (UES) basal pressure than those with normal EHAS (21.5% vs 11.8%, P = 0.024), while no significant difference was found in other proximal manometric parameters between the 2 groups. On multivariate analysis, high EHAS was independently associated with elevated UES basal pressure (OR, 2.19, P = 0.034).

Elevated UES basal pressure is more frequently seen in symptomatic patients with high esophageal hypervigilance and anxiety. When encountering patients with unexplained high UES basal pressure, psychological burden may play a potential role in these cases.