Psychother Psychosom Med Psychol 2002; 52(3/4): 159-165
DOI: 10.1055/s-2002-24957
Originalarbeit
© Georg Thieme Verlag Stuttgart · New York

Psychophysiologische Aspekte der gastroösophagealen Refluxkrankheit

Psycho-Physiological Aspects of Gastroesophageal Reflux DiseaseThomas  Kamolz1 , Tanja  Bammer1 , Martin  Pasiut1 , Rudolph  Pointner1
  • 1Abteilung für Allgemeinchirurgie A. ö. Krankenhaus, Zell am See
Weitere Informationen

Publikationsverlauf

27. 2. 01

27. 9. 01

Publikationsdatum:
08. April 2002 (online)

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.

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

    >