Somatic Symptom Disorder Is Associated with Cough Hypersensitivity and Poor Response to Anti-Reflux Therapy in...

Background/Objectives: Gastroesophageal reflux-induced chronic cough (GERC) is a common cause of chronic cough, and a substantial proportion of patients show an inadequate response to standard anti-reflux therapy. Psychological comorbidities, including somatic symptom disorder (SSD), have been increasingly recognized in this population. However, the prevalence and clinical characteristics of SSD in patients with GERC remain unclear. This study aimed to determine the prevalence of SSD in patients with GERC and to characterize the associated clinical and psychological features. Methods: In this prospective observational study, consecutive patients with GERC diagnosed at Tongji Hospital, Shanghai, China, between January 2024 and June 2025 were consecutively enrolled. SSD was assessed using a structured diagnostic interview based on DSM-5 criteria. Patients were categorized into SSD+ and SSD- groups. Clinical and psychological characteristics were compared between groups, and binary logistic regression was performed to identify factors associated with SSD. Results: A total of 215 patients with GERC were included, of whom 22.3% (48/215) were diagnosed with SSD. Compared with the SSD- group, patients with SSD had higher healthcare utilization, poorer response to standard anti-reflux therapy, increased cough sensitivity, poorer cough-related quality of life, and greater psychological distress. Multivariate logistic regression identified increased cough sensitivity and higher anxiety and depression scores as independent factors associated with SSD. Conclusions: SSD is relatively common in patients with GERC and is associated with cough hypersensitivity, poorer response to anti-reflux therapy, and greater psychological burden. These findings suggest that SSD may represent a clinically relevant phenotype of GERC, and patients with coexisting SSD may require more comprehensive psychosomatic assessment and multidisciplinary management.