PHYSIOLOGICAL AND PSYCHOLOGICAL FACTORS CONTRIBUTE TO REAL-TIME ESOPHAGEAL SYMPTOM REPORTING IN REFRACTORY REFLUX PATIENTS.

BACKGROUND

Real-time symptom reporting during ambulatory reflux monitoring plays a key role in the evaluation of esophageal symptoms, although the underlying processes are poorly understood. We aim to identify the psychological and physiological factors associated with real-time reflux symptom reporting and symptom-reflux association parameters.

METHODS

Adult patients with refractory reflux symptoms completed psychosocial questionnaires and standard 24-hour pH-impedance monitoring. A Hurdle-Poisson model evaluated the association between psychological and physiological (proton-pump inhibitor (PPI) use, total number of reflux episodes) variables on real-time symptom frequency, assessed via a button press within two minutes of experiencing a symptom. Logistic regression assessed the variables associated with symptom-association probability (SAP) and symptom index (SI) classification (positive/negative). Complementary machine learning analyses with 8-fold cross-validation further identified variables associated with symptom frequency and sought to optimize SAP classification performance.

FINDINGS

Both psychological (pain-related anxiety, depressive symptoms, trait anxiety) and physiological (total number of reflux episodes, off PPI during testing) variables were associated with symptom frequency. The total number of reflux episodes and being studied off PPI were significantly associated with a higher likelihood of being classified as SAP or SI positive. The best-performing model in the machine-learning analysis demonstrated a poor job of correctly classifying patients as SAP positive/negative (misclassification rate=41.4%).

INTERPRETATION

Real-time reflux symptom reporting is a multifactorial process, with both psychological and physiological processes contributing to different aspects of the reflux disease experience. Findings build on questionnaire-based research to underscore the importance of including psychological processes in our understanding of esophageal symptom reporting.

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