Gastroesophageal reflux disease. Heart-burn from a psychological view.

Although gastroesophageal reflux disease (GERD) can be traced back to disorders of the gastroesophageal junction, stress and other relevant psychological factors can play an important role in the process of GERD. It would seem that, primarily, altered symptom perception based on threshold reduction exists in some patients. In an effort to describe the sensitisation for reflux symptoms, both central and peripheral factors can be discussed. The following is conceivable: that well defined personality factors moderate the effect of stress on the gastroesophageal junction, just as they can influence the perception and assessment of symptoms. Additionally, psychiatric disorders as comorbidities can also accompany GERD. For this reason, it is necessary to consider if an extension of hitherto psychological interventions could be helpful in patients with a subjective link between reflux and stress on an emotional personality related level, or in patients with attendant psychiatric disorders. This broadening relates both to the conservative use of antireflux medication and to surgical therapy, since a postoperative shift in symptoms can occur. The effectiveness of psychological interventions in several gastrointestinal patient groups could already be shown in the past, whereas evidence for their effectiveness in patients suffering with GERD is partly still outstanding and should be investigated in the future especially as several individual promising starts have been made.