Associations of Psychological Distress with Esophageal Functional Metrics in Patients with Refractory Reflux-Like Symptoms: A Retrospective Study.

The primary objective of this study was to investigate the established correlations between psychological factors (anxiety, depression, and sleep quality) and esophageal physiological parameters. Additionally, this research aimed to examine the distribution patterns of these psychological factors across distinct subgroups of GERD symptom presentations. Retrospective analysis included 75 patients aged 18-70 with persistent reflux symptoms despite 8 weeks of proton pump inhibitor (PPI) therapy. Evaluations included esophagogastroduodenoscopy, high-resolution manometry, 24-hour pH-impedance monitoring, and psychological assessments (SAS, SDS, PSQI). Patients were grouped into refractory gastro-esophageal reflux disease (rGERD), functional heartburn (FH), and reflux hypersensitivity (RH). MNBI, PSPW-I, and EGJ-CI were compared, and correlations with psychological and sleep parameters were analyzed. Distal MNBI was significantly lower in rGERD (1177.91 ± 707.22 Ω) vs. FH (1995.77 ± 476.02 Ω) and RH (2062.35 ± 509.93 Ω) (P < 0.001). Anxiety prevalence was 85.7% in rGERD, 64.7% in FH, and 67.5% in RH (P = 0.302); depression affected 78.6% of rGERD, 70.8% of FH, and 72.9% of RH patients (P = 0.942). Poor sleep quality was present in > 80% of all groups. PSPW-I negatively correlated with anxiety (r = -0.181, P < 0.05) and depression (r = -0.158, P < 0.05), as did proximal MNBI with depression (r = -0.175, P < 0.05). A distal MNBI cutoff of 1531 Ω distinguished rGERD from FH/RH with 71.4% sensitivity and 87.5% specificity (AUC = 0.80). Anxiety, depression and poor sleep quality may reduce the efficacy of PPI. Distal MNBI effectively differentiates rGERD from FH/RH.