Oesophageal hypervigilance and visceral anxiety relate to reflux symptom severity and psychological distress but not to acid reflux parameters

Ming Wun Wong, Tso Tsai Liu, Chih Hsun Yi, Wei Yi Lei, Jui Sheng Hung, Charles Cock, Taher Omari, Chandra Prakash Gyawali, Shu Wei Liang, Lin Lin, Chien Lin Chen

Research output: Contribution to journalArticlepeer-review

21 Citations (Scopus)


Background: The pathogenesis of gastro-oesophageal reflux disease (GERD) is complex and multifactorial. The oesophageal hypervigilance and anxiety scale (EHAS) is a novel cognitive-affective evaluation of visceral sensitivity. Aims: To investigate the interrelationship between EHAS and reflux symptom severity, psychological stress, acid reflux burden, phenotypes, and oesophageal mucosal integrity in patients with GERD. Methods: Patients with chronic reflux symptoms and negative endoscopy underwent 24-hour impedance-pH monitoring for phenotyping, acid reflux burden, and mucosal integrity with mean nocturnal baseline impedance (MNBI) calculation. Validated scores for patient-reported outcomes, including EHAS, GERD questionnaire (GERDQ), State-Trait Anxiety Inventory score, and Taiwanese Depression Questionnaire score, were recorded. Results: We enrolled 105 patients, aged 21-64 years (mean, 48.8), of whom 58.1% were female; 27 had non-erosive reflux disease, 43 had reflux hypersensitivity and 35 had functional heartburn. There were no significant differences in sex, EHAS, GERDQ, questionnaires of depression or anxiety among GERD phenotypes. EHAS was significantly correlated with GERDQ, questionnaires of depression and anxiety (P < 0.05). However, there were no significant correlations between GERDQ and questionnaires of depression or anxiety. Regarding patient-reported outcomes, GERDQ positively correlated with acid exposure time and negatively correlated with MNBI (P < 0.05). Conclusions: EHAS associates with reflux symptom severity and psychological stress but not with acid reflux burden or mucosal integrity. Thus, EHAS assessment shows promise in assessment of subjective patient outcome and satisfaction with treatment, a hitherto unmet clinical need.

Original languageEnglish
Pages (from-to)923-930
Number of pages8
JournalAlimentary Pharmacology and Therapeutics
Issue number7
Early online date12 Aug 2021
Publication statusPublished - Oct 2021


  • gastro-oesophageal reflux disease (GERD)
  • reflux symptom severity
  • psychological stress
  • acid reflux burden
  • phenotypes
  • oesophageal mucosal integrity


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