Stress, personality and social support in gastro-oesophageal reflux disease

In 40% of patients presenting to medical clinics with heartburn, no objective evidence of gastro-oesophageal reflux disease can be demonstrated. Little research has been performed regarding the psychological characteristics of these patients. The aim of this study was to assess the psycho-social profiles of patients presenting with heartburn in an attempt to discriminate between those with pathological reflux and those with functional disease.

One hundred and thirty-eight patients presenting with heartburn underwent endoscopy and oesophageal pH monitoring. They were divided into those with oesophagitis or abnormal degrees of acid reflux into the oesophagus and those with normal endoscopy and normal pH profile. The psychological questionnaires used were the Hassles Scale, the State-Trait Anxiety Index, the Crown-Crisp Experiential Index and the Interview Schedule for Social Interaction.

Patients with functional heartburn did not report any increase in daily hassles nor did they have higher levels of anxiety, depression or other psychological characteristics than those with objective reflux disease. In terms of their available social support, the two groups were similar.

Differences in psychological characteristics and social support structures do not offer an explanation for the heartburn experienced by patients in the absence of objective evidence of reflux disease. Other explanations, including visceral hypersensitivity, should be sought in these patients.