Zusammenfassung
Bekannt ist, dass physiologische und psychologische Aspekte bei unterschiedlichen
gastrointestinalen Erkrankungen, auch bei ösophagealen Symptomen, relevant miteinander
interagieren können. Aufgrund dieser Interaktion liegen interdisziplinäre Therapiekonzepte
vor, um verschiedene gastrointestinale Krankheitsbilder ganzheitlich behandeln zu
können. Die Wirkungsweise psychologischer Faktoren bei der gastroösophagealen Refluxkrankheit
ist hingegen großteils unklar und nicht eindeutig. Der vorliegende Artikel bietet
einen Überblick bezüglich der pathophysiologischen Ursachen, möglicher psychophysiologischer
Zusammenhänge und medizinischer sowie etwaiger psychologischer Behandlungskonzepte
der gastroösophagealen Refluxkrankheit.
Abstract
It is well known that there is an interaction between physiological and psychological
aspects of gastrointestinal diseases, also in esophageal symptoms. Based on this bio-psycho-social
interaction, several multidisciplinary concepts of interventions in gastrointestinal
disorders have been evaluated. The role of psychological factors in gastroesophageal
reflux disease (GERD) is really unknown. The present article reviews the basic pathophysiological
factors of GERD including psycho-physiological aspects and presents potential concepts
of multidisciplinary GERD treatment.
Key words
Gastroesophageal reflux disease - Psychology - Psychophysiology - Review
Literatur
- 1
Armstrong D.
Reflux disease and Barrett's Oesophagus.
Endoscopy.
1994;
26
9-19
- 2
Collen M J, Abdulian J D, Chen Y K.
Gastroesophageal reflux disease in the elderly: More severe disease that requires
aggressive therapy.
Am J Gastroenterol.
1995;
90
1053-1057
- 3
Dent J, Brun J, Fendrick A M. et al .
An evidence-based appraisal of reflux disease management - the Genval Workshop report.
Gut.
1999;
44
1-16
- 4
Klauser A G, Schindlbeck N E, Müller-Lissner S A.
Symptoms in gastroesophageal reflux disease.
Lancet.
1990;
335
205-208
- 5
DeMeester T R, Johnson L S, Guy J J. et al .
Patterns of gastroesophageal reflux in health and disease.
Ann Surg.
1976;
184
459-470
- 6
Johnson L F, DeMeester T R.
Twenty-four hour pH monitoring of the distal esophagus.
Am J Gastroenterol.
1974;
62
1200-1205
- 7
Lagergren J, Bergstrom R, Lindgren A, Nyren O.
Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma.
N Engl J Med.
1999;
340
825-831
- 8
Lind T, Havelund T, Carlsson R. et al .
Heartburn without esophagitis: efficacy of omeprazole therapy and features determining
therapeutic response.
Scand J gastroenterol.
1997;
32
974-979
- 9
Fass R, Fennerty M B, Ofman J J. et al .
The clinical and economic value of a short course of omeprazole in patients with noncardiac
chest pain.
Gastroenterol.
1998;
115
42-49
- 10
Clouse R E, Richter J E, Heading R C, Janssen J, Wilson J A.
Functional esophageal disorders.
Gut.
1999;
45
31-36
- 11 DeMeester T R, Stein H J, Fuchs K H.
Diagnostic studies in the evaluation of the esophagus: Physiologic diagnostic studies. In: Orringer (ed) Shackelfords's surgery of the alimentary tract. Philadelphia; Saunders
1991 3rd edn: 94-126
- 12
Fuchs K H, Freys S M, Heimbucher J, Fein M, Thiede A.
Pathophysiologic spectrum in patients with gastroesophageal reflux disease in a surgical
GI function laboratory.
Dis Esoph.
1995;
8
211-217
- 13
Sampliner R E.
Practice guidelines on the diagnosis, surveillance and therapy of Barrett's esophagus.
Am J Gastroenterol.
1998;
93
1028-1032
- 14
Richter J E.
Management of gastro-esophageal reflux disease. Pathophysiological basis of therapy
for gastroesophageal reflux disease.
Dis Esoph.
1995;
7
223-229
- 15
Kahrilas P J.
Hiatus hernia causes reflux: fact or fiction.
Gullet.
1993;
3
21-30
- 16
O'Connor H B, Falk G W, Richter J E.
The incidence of adenocarcinoma and dysplasia in Barrett's esophagus: report of the
Cleveland Clinic Barrett's Esophagus Registry.
Am J Gastroenterol.
1999;
94
2037-2042
- 17
Vacari J J, Peek R M, Falk G W. et al .
The seroprevalence of cagA positive Helicobacter pylori strains in the spectrum of
gastroesophageal reflux disease.
Gastroenterol.
1998;
115
50-57
- 18
Varanasi R V, Fantry G T, Wilson K T.
Decreased prevalence of Helicobacter pylori infection in gastroesophageal reflux disease.
Helicobacter.
1998;
3
188-194
- 19
Labenz J, Blum A L, Bayerdorffer E, Meining A, Stolte M, Borsch G.
Curing Helicobacter pylori infection in patients with duodenal ulcer may provoke reflux
esophagitis.
Gastroenterol.
1997;
112
1442-1447
- 20
Malfertheiner P, Veldhuyzen van Zanten S, Dent J. et al .
Does cure of helicobacter pylori infection induce heartburn?.
Gastroenterol.
1998;
44
A870
- 21
Banatvala N, Mayo K, Megraud F, Jennings R, Deeks J J, Feldman R A.
The cohort effect and helicobacter pylori.
J Infect Dis.
1993;
168
219-221
- 22
DeVault K R, Castell D O.
Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease.
Am J Gastroenterol.
1999;
94
1434-1442
- 23 A Gallup survey on heartburn across America: The Gallup Organisation. New York;
Princeton 1988
- 24
Bradley A, Richter J E, Pulliam T J. et al .
The relationship between stress and symptoms of gastroesophageal reflux: The influence
of psychological factors.
Am J Gastroenterol.
1993;
88
11-19
- 25
Baldi F, Ferrarini P, Longanesi A, Ragazzini M, Barbara L.
Acid gastroesophagael reflux and symptom occurence. Analysis of some factors influencing
their association.
Dig Dis Sci.
1989;
34
1890-1893
- 26
Johnson D A, Winters C, Spurling T J, Chobanian S J, Cattau E L.
Esophageal acid sensitivity in Barrett's esophagus.
J Clin Gastroenterol.
1987;
9
23-27
- 27
Singh S, Richter J E, Bradley L A, Haile J M.
The symptom index: differential usefulness in suspected acid-related complaints of
heartburn and chest pain.
Dig Dis Sci.
1993;
38
1402-1408
- 28
Jacobson E.
Voluntary relaxation of the esophagus.
Am J Physiol.
1925;
72
387-392
- 29
Jacobson E.
Spastic esophagus and mucous colitis.
Arch Int Med.
1927;
39
433-438
- 30
Rubin J, Nagler R, Spiro H M, Pilot M L.
Measuring the effect of emotions on esophageal motility.
Psychosom Med.
1962;
24
170-176
- 31
Young L D, Richter J E, Anderson K O. et al .
The effects of psychological and environmental stressors on peristaltic esophageal
contractions in healthy volunteers.
Psychophysiology.
1987;
24
132-141
- 32
Ayres R CS, Robertson D AF, Naylor K, Smith C L.
Stress and esophageal motility in normal subjects and patients with irretable bowel
syndrome.
Gut.
1989;
30
1540-1543
- 33
Anderson K O, Dalton C B, Bradley L A, Richter J E.
Stress induces alterations of esophageal pressures in healthy and non-cardiac chest
pain patients.
Dig Dis Sci.
1989;
34
83-91
- 34
Penagini R, Bartesaghi B, Bianchi P A.
Effect of cold stress on postprandial lower esophageal sphincter competence and gastroesophageal
reflux in healthy subjects.
Dig Dis Sci.
1992;
37
1200-1205
- 35
Mittal R K, Stewart W R, Ramahi M, Chen J, Rarace E.
Psychological stress increases tonic and phasic activity of the crural diaphragm and
impairs relaxation of the lower esophageal sphincter.
Gastroenterol.
1992;
102
A 487
- 36
Cook I J, Collins S M.
Does acute emotional stress influence frequency or duration of gastroesophageal reflux
in human subjects?.
Gastroenterol.
1986;
90
A 1380
- 37
Sonnenberg A, Donga M, Erckenbrecht J F, Wienbeck M.
The effect of mental stress induced by noise on gastric acid secretion and mucosal
blood flow.
Scand J Gastroenterol.
1984;
19
45-48
- 38
Holtman G, Kriebel R, Singer M V.
Mental stress and gastric acid secretion: Do personality traits influence the response?.
Dig Dis Sci.
1990;
35
998-1007
- 39
Baker L H, Lieberman D, Oehlke M.
Psychological distress in patients with gastroesophageal reflux disease.
Am J Gastroenterol.
1995;
90
1797-1803
- 40
Johnston B T, Lewis S A, Collins S A. et al .
Acid perception in gastro-esophageal reflux disease is dependent on psychosocial factors.
Scand J Gastroenterol.
1995;
30
1-5
- 41
Tew S, Jamieson G G, Pilowsky I, Myers J.
The illness behavior of patients with gastroesophageal reflux disease with and without
endoscopic esophagitis.
Dis Esophagus.
1997;
10
9-15
- 42
Trimble K C, Pryde A, Heading R C.
Lowered esophageal sensory thresholds in patients with symptomatic but not excess
gastro-esophageal reflux disease: evidence for a spectrum of visceral sensitivity
in GORD.
Gut.
1995;
37
7-12
- 43
Johnston B T, McFarland R J, Collins J SA. et al .
Effect of acute stress on oesophageal motility in patients with gastro-esophageal
reflux disease.
Gut.
1996;
38
492-497
- 44
Galmiche J P, Varannes S B.
Endoscopi-negative reflux disease.
Curr Gastroenterol Rep.
2001;
3
206-214
- 45
Cohen S, Snape W J.
The role of psychophysiological factors in disorders of esophageal function.
Clin Gastroenterol.
1977;
6
569-579
- 46 Goyal R K, Skarupta J N, Saha J K.
Properties of esophageal mechanosensitive receptors. In: Holle GE, Wood JD (eds) Advances in the innervation of the gastrointestinal tract. Elsevier
1992: 523-537
- 47 Grundy D.
Extrinsic reflex pathways in the upper gastrointestinal tract and their central processing. In: Holle GE, Wood JD (eds) Advances in the innervation of the gastrointestinal tract. Elsevier
1992: 539-546
- 48
Kellow J E, Delvaux M, Azpiroz F, Camillieri M, Quigley E MM, Thompson D G.
Principles of applied neurogastroenterology: physiology/motility-sensation.
Gut.
1999;
45
17-24
- 49
Drossman D A, Creed F H, Olden K W, Svedlund J, Toner B B, Whitehead W E.
Psychosocial aspects of functional gastrointestinal disorders.
Gut.
1999;
45
25-30
- 50
Nielzen S, Pettersson K I, Regnell G, Svenson R.
The role of psychiatric factors in symptoms of hiatus hernia or gastric reflux.
Acta Psychiatr Scand.
1986;
73
214-220
- 51
Clouse R E, Lustman P J.
Psychiatric illness and contraction abnormalities of the esophagus.
N Engl J Med.
1983;
309
1337-1342
- 52
Feldman M, Walker P, Goldschmiedt M, Cannon D.
Role of affect and personality in acid secretion and serum gastrin concentration.
Gastroenterol.
1992;
102
175-180
- 53
Kamolz T, Bammer T, Wykypiel H, Pointner R.
Stressverarbeitung und Persönlichkeitsstruktur bei Patienten mit und ohne stressassoziierter
Symptomatik der gastroösophagealen Refluxkrankheit.
Z Gastroenterol.
1999;
37
265-270
- 54
Velanovich V, Karmy-Jones R.
Measurement gastroesophageal reflux disease: relationship between health-related quality
of life score and physiologic parameters.
Am Surg.
1998;
64
649-653
- 55
Janssens J P, Vantrappen G.
Irritable esophagus.
Am J Med.
1992;
92
27-32
- 56
Shi G, Tatum R P, Joehl R J, Kahrilas P J.
Esophageal sensitivity and symptom perception in gastroesophageal reflux disease.
Curr Gastroenterol Rep.
1999;
1
214-219
- 57
Vaezi M F, Richter J E.
Importance of duodeno-gastro-esophageal reflux in the medical outpatient practice.
Hepatogastroenterol.
1999;
46
40-47
- 58
Norton G R, Norton P J, Asmundson G J, Thompson L A, Larsen D K.
Neurotic butterflies in my stomach: the role of anxiety, anxiety sensitivity and depression
in functional gastrointestinal disorders.
J Psychosom Res.
1999;
47
233-240
- 59
Johnston B T, Lewis S A, Love A H.
Stress, personality and social support in gastro-esophageal reflux disease.
J Psychosom Res.
1995;
39
221-226
- 60
Dexault K R, Achem S R.
Functional Gastroesophageal Reflux Disease.
Curr Treat Options Gastroenterol.
2000;
3
295-302
- 61
Clouse R E, Lustman P J, Eckert T C. et al .
Low-doses trazodone for symptomatic patients with esophageal contraction abnormalities:
double-blind, placebo-controlled trial.
Gastroenterol.
1986;
92
1027-1036
- 62 Schuster M M.
Disorders of the esophagus: Application of psychophysiological methods in treatment. In: Hözl R, Whitehead WE (eds) Psychophysiology of the gastrointestinal tract. New
York; Plenum 1983: 33-42
- 63
Shay S S, Johnson L F, Wong R KH. et al .
Rumination, heartburn, and daytime gastroesophageal reflux: A case study with mechanism
defined and successfully treated with biofeedback therapy.
J Clin Gastroenterol.
1986;
8
115-126
- 64
Gordon A, Gordon E, Berelowitz M. et al .
Biofeedback improvement of lower esophageal sphincter pressures and reflux symptoms.
J Clin Gastroenterol.
1983;
5
235-237
- 65
Klein K B, Speigel D.
Modulation of gastric acid secretion by hypnosis.
Gastroenterol.
1989;
96
1383-1387
- 66
McDonald-Haile J, Bradley L A, Baily M A, Schan C A, Richter J E.
Relaxation training reduces symptom reports and acid exposure in patients with gastroesophageal
reflux disease.
Gastroenterol.
1994;
107
61-69
- 67
Watson D I, Chan A SL, Myers J C, Jamieson G G.
Illness behavior influences the outcome of laparoscopic antireflux surgery.
J Am Coll Surg.
1997;
184
44-48
- 68
Kamolz T, Bammer T, Pointner R.
Predictability of dysphagia after laparoscopic Nissen fundoplication.
Am J Gastroenterol.
2000;
95
408-414
- 69
Kamolz T, Granderath F A, Bammer T, Pasiut M, Pointner R.
Psychological intervention influences the outcome of laparoscopic antireflux surgery
in patients with stress-related symptoms of gastroesophageal reflux disease.
Scand J Gastroenterol.
2001;
36
800-805
- 70
Walker E A, Katon W J, Jemelka R P, Roy-Bryne P P.
Comorbidity of gastrointestinal complaints, depression, and anxiety in the Epidemiologic
catchment Area (ECA) Study.
Am J Med.
1992;
92
26-30
- 71
Hochstrasser B, Angst J.
The Zürich Study: XXII. Epidemiology of gastrointestinal complaints and comorbidity
with anxiety and depression.
Eur Arch Psychiatry Clin Neurosci.
1996;
246
261-272
- 72
Lydiard R B, Greenwald S, Weissman M M. et al .
Panic disorder and gastrointestinal symptoms: findings from the NIMH Epidemiologic
Catchment Area project.
Am J Psychiatry.
1994;
151
64-70
- 73
Ros E, Armengol X, Grande L. et al .
Chest pain at rest in patients with coronary artery disease. Myocardial ischemia,
esophageal dysfunction, or panic disorders?.
Dig Dis Sci.
1997;
42
1344-1353
- 74
Maunder R G.
Panic disorders associated with gastrointestinal disease: review and hypotheses.
J Psychosom Res.
1998;
44
91-105
- 75
Eldridge G D, Walker J R, Holborn S W.
Cognitive-behavioral treatment for panic disorder with gastrointestinal symptoms:
a case study.
J Behav Ther Exp Psychiatry.
1993;
24
367-371
- 76
Kamolz T, Bammer T, Granderath F A, Pointner R.
Laparoscopic antireflux surgery in GERD patients with concomitant anxiety disorders.
Dig Liver Dis.
2001;
33 (in press)
Dr. Mag. Thomas Kamolz
Abteilung für Allgemeinchirurgie · A. ö. Krankenhaus Zell am See
5700 Zell am See · Österreich
Email: kamolz@utanet.at