One-Third of Adults With GERD Have Anxiety; Bidirectional Relationship Likely

Many adults with gastroesophageal reflux disease (GERD) experience symptoms of anxiety and depression, suggesting a bidirectional causal relationship, according to a recent study published in the American Journal of Gastroenterology.

“This systematic review and meta-analysis showed a high prevalence of common psychological comorbidities among individuals with GERD, with up to one-third and one-fourth of subjects affected by anxiety and depressive symptoms, respectively,” researchers noted. “Assessment for comorbid anxiety and depression in patients with GERD and screening for GERD in anxious/depressive patients may have implications for clinical outcomes and quality of life.”

Researchers conducted searches on Embase, PubMed, Scopus, and Web of Science and pulled relevant observational, cohort, and Mendelian randomization studies. The observational studies reported anxiety/depression symptom prevalence as diagnosed by validated questionnaires in ≥100 adults with GERD. The cohort studies explored the risk of incident GERD in subjects with anxiety/depression vice versa scenario, and the Mendelian randomization studies assessed the cause-and-effect relationship between anxiety/depression and GERD. Researchers combined data from all studies using a random-effects model.

The analysis included 36 studies that met selection criteria. Among adults with GERD, approximately 34.4% exhibited symptoms of anxiety (95% confidence interval [CI] 24.7–44.2; I2 = 99.4%) and 24.2% experienced depressive symptoms (95% CI 19.9–28.5; I2 = 98.8%). These rates were higher than those observed in healthy individuals. Researchers also found a 4.46 times higher likelihood of anxiety and a 2.56 times higher likelihood of depression in subjects with GERD compared to healthy controls.

Of the included cohort studies, 3 demonstrated that individuals with GERD faced an elevated risk of developing anxiety and depression over time and vice versa. Additionally, in the Mendelian randomization studies, the research revealed a genetic connection between anxiety/depression and GERD. Genetic predisposition to mood disorders was associated with an increased risk of developing GERD, and vice versa, indicating a bidirectional causal relationship.

Mohammad Z, Alizadeh-Tabari S, Walter WC, et al. Association between anxiety/depression and gastroesophageal reflux: a systematic review and meta-analysis. Am J Gastroenterol. Published online August 21, 2023. DOI: 10.14309/ajg.0000000000002411