Vol.:(0123456789) 1 3 Surgical Endoscopy https://doi.org/10.1007/s00464-019-06716-y Minor psychiatric disorders and objective diagnosis of gastroesophageal refux disease Rafael Melillo Laurino Neto 1  · Fernando A. M. Herbella 1,2  · Andre Zugman 3  · Vic Velanovich 4  · Beth Montera 4  · Francisco Schlottmann 5  · Marco G. Patti 5 Received: 18 September 2018 / Accepted: 19 February 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2019 Abstract Background Symptoms may be unreliable to diagnose gastroesophageal refux disease (GERD) in patients with minor psy‑ chiatric disorders (MPD). This study aims to evaluate the infuence of MPD in the diagnosis of GERD. Methods We prospectively studied 245 patients (based on a sample size calculation) with suspected GERD. All patients underwent manometry and pH monitoring and MPD evaluation based on the Hospital Anxiety and Depression Scale (HADS). Results Based on the results of the pH monitoring, patients were classifed as GERD + (n = 136, 55% of the total, mean age 46 years, 47% females) or GERD − (n = 109, 45% of the total, mean age 43 years, 60% females). The mean HADS score for GERD + and GERD − for anxiety was 7.8 and 8.5, respectively (p = 0.8) and for depression was 5.4 and 6.1, respectively (p = 0.1). DeMeester score (DS) did not correlate with total HADS score (p = 0.08) or depression domain (p = 0.9) but there was a negative correlation between DS and anxiety level (p < 0.001). A signifcant threshold accuracy value for HADS to diagnose GERD was not found on receiver operating characteristics curve analysis. Conclusion Almost half of the patients evaluated for GERD did not have the disease on objective evaluation. GERD + and GERD − patients had similar levels of MPD. However, the amount of refux correlated negatively with the severity of anxiety. Symptoms and HADS cannot accurately diagnose or exclude GERD. pH monitoring should be more liberally used especially in patients with high levels of anxiety. Keywords Gastroesophageal refux disease · Esophageal pH monitoring · Anxiety · Depression · Surveys and questionnaires Gastroesophageal refux disease (GERD) is defned as the clinical condition that occurs due to the retrograde fow of gastroduodenal contents into the esophagus or adjacent organs, causing symptoms and/or mucosal damage [1]. It has a high prevalence in several continents with individuals presenting at least one episode of heartburn from 2 to 8% in Asia and from 18 to 28% in North America [2]. GERD diagnosis based on symptoms only, even with the use of dedicated questionnaires, has a sensitivity lower than 40% [3]. Upper endoscopy has low sensitivity for confrming the diagnosis, as some patients can have a normal endoscopy without mucosal damage [4]. Esophageal ambulatory pH monitoring, on the other side, is an important tool for the objective diagnosis of GERD with specifcity around 90% and sensitivity around 95% [5, 6]. GERD symptoms in the absence of pathologic refux may occur when psychiatric disorders participate as one of the triggering factors [7, 8]. The frequency and duration of GERD symptoms [9, 10] as well as worse outcomes for clinical [10, 11] or surgical [12] therapies for GERD have been linked to the concomitance of MPD, however, there are still few studies on the infuence of these diseases in the diagnosis of GERD. and Other Interventional Techniques * Fernando A. M. Herbella herbella.dcir@epm.br 1 Department of Surgery, Escola Paulista de Medicina, Rua Diogo de Faria 1087, cj 301, São Paulo, SP 04037‑003, Brazil 2 Hospital São Luiz Morumbi, São Paulo, Brazil 3 Department of Psychiatry, Escola Paulista de Medicina, São Paulo, Brazil 4 Department of Surgery, University of South Florida, Tampa, US 5 University of North Carolina at Chapel Hill, Chapel Hill, USA