Psychological Processes, Not Physiological Parameters, Are Most Important Contributors to Symptom Severity in Patients With Refractory Heartburn/Regurgitation Symptoms

Livia Guadagnoli*, Annelies Geeraerts, Hannelore Geysen, Ans Pauwels, Tim Vanuytsel, Jan Tack, Lukas Van Oudenhove

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

Abstract

Background & Aims: Physiological and psychological factors have been found to influence esophageal symptom reporting. We aimed to evaluate which of these factors are associated with 3 reflux symptom severity outcomes (ie, Total Reflux, Heartburn, and Sleep Disturbance) through a traditional statistical and a complementary machine-learning approach. Methods: Consecutive adult patients with refractory heartburn/regurgitation symptoms underwent standard 24-hour pH-impedance monitoring and completed questionnaires assessing past and current gastrointestinal and psychological health. In the traditional statistical approach, hierarchical general linear models assessed relationships of psychological and physiological variables (eg, total number of reflux episodes) with reflux severity scores. Mediation analyses further assessed pathways between relevant variables. In the machine-learning approach, all psychological and physiological variables were entered into 11 different models and cross-validated model performance was compared among the different models to select the best model. Results: Three hundred ninety-three participants (mean [SD] age, 48.5 [14.1] years; 60% were female) were included. General psychological functioning emerged as an important variable in the traditional statistical approach, as it was significantly associated with all 3 outcomes and mediated the relationship between childhood trauma and both Total Reflux and Heartburn Severity. In the machine-learning analyses, general psychological variables (eg, depressive symptoms) were most important for Total Reflux and Sleep Disturbance outcomes, and symptom-specific variables, like visceral anxiety, were more influential for Heartburn Severity. Physiological variables were not significant contributors to reflux symptom severity outcomes in our sample across reflux classifications and statistical methodology. Conclusions: Psychological processes, both general and symptom-specific, should be considered as another important factor within the multifactorial processes that impact reflux symptom severity reporting across the reflux spectrum.

Original languageEnglish (US)
Pages (from-to)848-860
Number of pages13
JournalGastroenterology
Volume165
Issue number4
DOIs
StatePublished - Oct 2023

Funding

Figures 1–3 and Supplementary Figures 1 and 2 were created with BioRender.com. Livia Guadagnoli, PhD (Conceptualization: Equal; Formal analysis: Lead; Methodology: Equal; Writing – original draft: Equal; Writing – review & editing: Equal). Annelies Geeraerts, MS (Conceptualization: Equal; Formal analysis: Supporting; Methodology: Equal; Writing – original draft: Equal; Writing – review & editing: Equal). Hannelore Geysen, PhD (Data curation: Equal; Project administration: Equal; Writing – review & editing: Equal). Ans Pauwels, PhD (Data curation: Equal; Project administration: Equal; Writing – review & editing: Equal). Tim Vanuytsel, MD, PhD (Conceptualization: Equal; Methodology: Equal; Supervision: Equal; Writing – review & editing: Equal). Jan Tack, MD, PhD (Conceptualization: Equal; Methodology: Equal; Supervision: Equal; Writing – review & editing: Equal). Lukas Van Oudenhove, MD, PhD (Conceptualization: Equal; Formal analysis: Lead; Methodology: Equal; Supervision: Lead; Writing – original draft: Equal; Writing – review & editing: Equal). Funding Livia Guadagnoli is a postdoctoral research fellow of the Research Foundation Flanders (FWO, 12A7822N). Tim Vanuytsel is a senior clinical research fellow of the Research Foundation Flanders (FWO, 1830517N). Lukas Van Oudenhove is a research professor funded by the Katholieke Universiteit Leuven Special Research Fund. Funding Livia Guadagnoli is a postdoctoral research fellow of the Research Foundation Flanders (FWO, 12A7822N). Tim Vanuytsel is a senior clinical research fellow of the Research Foundation Flanders (FWO, 1830517N). Lukas Van Oudenhove is a research professor funded by the Katholieke Universiteit Leuven Special Research Fund.

Keywords

  • Anxiety
  • Depression
  • Functional Heartburn
  • Gastroesophageal Reflux Disease
  • Health Psychology

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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