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Rafael Laurino Neto1, Fernando A. M. Herbella*1, Vic Velanovich2, Beth Montera2, Francisco Schlottmann3, Marco G. Patti3
1Department of Surgery, Federal University of Sao Paulo, Sao Paulo - SP, Sao Paulo, Brazil; 2Department of Surgery, University of South Florida, Tampa, FL; 3Department of Surgery, University of North Carolina, Chapel Hill, NC

Background: Minor Psychiatric Disorders (MPD) such as anxiety and depression, may be mimic the clinical presentation of GERD. The association between MPD and functional gastrointestinal disorders is well established, but the same is not true for GERD. Some studies showed a higher prevalence of GERD in depression and a higher incidence of MPD in GERD series. The myriad of symptoms related to GERD and the possibility that these symptoms may also be caused by diseases other than GERD makes the diagnosis based on symptoms less reliable when compared to objective evaluation (pHmonitoring). We hypothesize that GERD symptoms are unreliable to diagnose GERD in patients with MPD. This study aims to evaluate the influence of MPD in the diagnosis of GERD.
Methods: We prospectively studied 222 patients with suspected GERD (54% female, mean age 44 ± 13) based on a sample size calculation. All patients underwent pH monitoring and MPD evaluation based on the Hospital Anxiety and Depression Scale (HADS), which is a questionnaire with 14 items, seven of which are focused on the assessment of anxiety (HADS-A) and seven for depression (HADS-D), for each of which is assigned from 0 to 3 points. GERD was defined as a DeMeester score > 14.7.
Results: 127 (57%) were GERD + and 95 (43%) GERD -. The mean DeMeester score for GERD + and GERD - was 44±33 and 7±4, respectively. The mean HADS score for anxiety for GERD + and GERD - was 8 (p=0.2). The mean HADS score for depression for GERD + and GERD - was 5 and 6, respectively (p=0.3). The DeMeester score did not correlate with total HADS score (p=0.9), anxiety domain (p=0.7) or depression domain (p=1). A subanalysis including only patients with extra-esophageal symptoms also did not show correlation between HADS and GERD diagnosis.
Conclusion: Almost half of the patients with MPD and a clinical diagnosis of GERD have a normal esophageal acid exposure by pH monitoring. As symptoms are unreliable for establishing the presence of GERD, objective evidence of the presence of pathologic reflux should be present before initiating treatment.

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