Patients with previously diagnosed anxiety disorders have been reported to have less improvement in patient-reported outcome measures (PROMs) following laparoscopic anti-reflux surgery (LARS). Additionally, the objective pathology does not seem to correlate well with symptom severity.

A study by Hill and colleagues evaluated if anxiety and hypervigilance, assessed preoperatively with esophageal hypervigilance anxiety scale (EHAS), is linked to improvement in gastroesophageal reflux disease (GERD)-specific PROMs and EHAS scores at 6 months following LARS.

This retrospective cohort study included 102 adult patients (average age 64) who underwent LARS. In the preoperative assessment, investigators collected data on baseline GERD-health-related quality of life (GERD-HRQL), laryngopharyngeal reflux symptom index (LPR-RSI) and EHAS scores, besides standard reflux workup, including endoscopy, manometry, barium swallow, and pH study. For all three surveys, a higher score points to worse symptom severity. Six months after surgery, 70 patients again completed GERD-HRQL, LPR-RSI, and EHAS surveys. Investigators assessed the surgical and patient-related factors linked to improvement in the 6-month postoperative GERD-HRQL and LPR-RSI scores.

• A statistically significant reduction was evident in the GERD-HRQL (25 vs. 2, p < 0.001), LPR-RSI (17 vs. 3, p < 0.001) and EHAS (34 vs. 15, p < 0.001) 6 months following LARS.
• On multivariable linear regression analysis, a higher baseline EHAS score had an independent association with a greater improvement in GERD-HRQL (β 0.35, p < 0.001) and LPR-RSI (β 0.19, p = 0.03) 6-months after LARS.
• The extent of improvement in EHAS, GERD-HRQL, and LPR-RSI was not affected by the type of LARS performed or disease severity.

The results suggest that measures of psychoemotional health are better correlated with symptom intensity compared with objective pathology.

Patients with a higher EHAS score tend to have greater symptom severity and a lower quality of life at baseline. Patients with a higher preoperative EHAS score, a measure of psychoemotional health, attain greater benefit from surgery rather than less benefit, as has been the view in the literature.

Source: Hill C, Crijns T, Nofal Y, et al. Finding relief for the self-conscious esophagus: laparoscopic anti-reflux surgery and the esophageal hypersensitivity and anxiety scale. Surg Endosc. 2022 Feb 19.