[Reflux, esophageal motility, and psychological characteristics of patients with gastroesophageal reflux disease-related chest pain and the association with chest pain symptom].

Objective: To analyze reflux, esophageal motility, and psychological characteristics of patients with gastroesophageal reflux disease (GERD)-related chest pain and the association with chest pain symptom. Methods: The patients with GERD who underwent 24-hour impedance-pH monitoring and high-resolution esophageal manometry at Peking University Third Hospital from July 2016 to April 2024 were retrospectively included. The psychometric scale, reflux monitoring and esophageal manometry were collected. According to the presence of chest pain, the patients were divided into chest pain group (with chest pain symptom) and non-chest pain group. The reflux, esophageal motility and psychological characteristics were compared between the two groups. Correlation analysis was used to identify the related characteristics of chest pain, and multivariate logistic regression model was used to analyze the risk factors for chest pain symptom. Results: A total of 272 patients with GERD were included, comprising 175 males and 97 females, with a median age[M (Q1, Q3)] of 49 (38, 58) years. There were 153 cases in the chest pain group and 119 cases in the non-chest pain group. The chest pain group exhibited a lower prevalence of hiatal hernia [17.6% (27/153) vs 37.8% (45/119)] and lower esophageal acid exposure time (AET) [2.0% (0.6%, 4.7%) vs 4.3% (1.1%, 8.2%)], compared to the non-chest pain group (all P<0.001). The chest pain group demonstrated significantly higher scores on the Symptom Checklist-90 (SCL-90) [133 (112, 173) vs 108 (99, 134) scores, P<0.001], Self-rating Anxiety Scale (SAS) [44 (38, 49) vs 39 (31, 45) scores, P<0.001], and Self-rating Depression Scale (SDS) [48 (38, 57) vs 43 (34, 54) scores, P=0.014], compared to the non-chest pain group. The occurrence of chest pain showed positive correlations with SAS (r=0.274), SDS (r=0.134), and SCL-90 (r=0.369)scores, whereas negative correlations were observed with hiatal hernia (r=-0.227) and AET (r=-0.215) (all P<0.05). Multivariate logistic regression analysis identified elevated SCL-90 score (OR=1.02, 95%CI: 1.01-1.03) and SAS score (OR=1.05, 95%CI: 1.01-1.10) as the risk factors for GERD-related chest pain. Conclusions: Compared with GERD patients without chest pain, those with chest pain had a lower incidence of esophageal hiatal hernia, lower AET, and increased mental and psychological abnormalities. Elevated SCL-90 and SAS scores were identified as the risk factors for GERD-related chest pain.