Anxiety

Is the anxiety of the diagnosis of Barrett's Oesophagus worse than the reality of the prognosis?

Diagnosed with a condition they’ve never heard of, patients turn to the internet where they will find scare stories, particularly in regard to the possible progression to cancer.

The following are just a handful of the hundreds of comments posted from Fearful Newly Diagnosed (FND) patients diagnosed with Barrett's Oesophagus.

It does have to be stressed, although there is an increased risk of cancer, for those identified as having Barrett’s the risk is very low particularly as they will receive medication that probably reduces those risks (see this page) and regular surveillance scoping would detect pre-cancerous changes early enough to be successfully treated.

From some recently published papers:

"Patients with Barrett's esophagus overestimate their risk of developing esophageal adenocarcinoma and will accept low success rates and high risk of complications to undergo endoscopic therapy. " [c-vii]

"greater emphasis on patient-centered communication strategies during conversations about Barrett's esophagus and cancer risk may be helpful for reducing patients' psychological distress" [c-viii]

"After you tell a patient that they have Barrett's and that only a very small minority develop cancer, just stop. Stop and acknowledge that you said a very scary word, 'cancer.'" [c-ix]

"Evidence is mounting that disease labels affect people’s psychological responses and their decisions about management options" [c-x]

"Using loaded labels such as “cancer” can make patients more worried ... which can cause them to choose more aggressive management options—with more risk of harm." [c-xi]

Does Acid Reflux cause anxiety or does anxiety cause acid reflux?

Recent studies show an association.

This 2018 study in the Journal of Neurogastroenterology and Motility, "Association Between Anxiety and Depression and Gastroesophageal Reflux Disease: Results From a Large Cross-sectional Study" concluded "This cross-sectional study revealed that anxiety and depression levels were significantly higher in subjects with GERD (notably in the NERD) than in controls."

This 2021 article from VerWell Health, The Connection Between GERD and Anxiety, summarised, "One thing that is known for certain is that there is an association between GERD and anxiety. We do not know, however, the exact relationship of how these two conditions interact.
"It may be that having an anxiety disorder predisposes you to develop GERD, either through psychological factors or physiological factors that increase stomach acid. Conversely, it may be that GERD symptoms like insomnia, chest pain, and heartburn create a stress response in the body which triggers anxiety."

This 2022 paper in Medical News Today, Acid reflux and anxiety: What to know, states, "Acid reflux and anxiety may share a close link. Some research suggests that anxiety might make acid reflux symptoms worse."

From a 2019 study published in Cureus, Depression and Anxiety in Patients with Gastroesophageal Reflux Disorder With and Without Chest Pain, “We found high levels of depression and anxiety in GERD patients with and without chest pain. Anxiety and depression levels were significantly higher in patients with chest pain than in those without chest pain. This may be due to the patient’s perception that chest pain is a sign of serious ailment, which may contribute to higher levels of psychological burden which includes anxiety and depression”

From a 2021 paper in Neurogastroenterology & Motility, Increased visceral sensitivity, elevated anxiety, and depression levels in patients with functional esophageal disorders and non-erosive reflux disease, “Increased sensation to visceral stimuli as well as anxiety and depression appears to play an important role not only in reflux hypersensitivity and functional heartburn ... but also in NERD.”

From Surgical Endoscopy in 2022, Finding relief for the self-conscious esophagus: laparoscopic anti-reflux surgery and the esophageal hypersensitivity and anxiety scale “Novel findings to this study are that patients with a higher [anxiety level] actually benefitted more from surgery.”

From Neuropsychiatric disease and treatment in 2022, Correlation Between Refractory Laryngopharyngeal Reflux Disease and Symptoms of Anxiety and Depression “Anxiety and depressive symptoms influence the occurrence, development, and treatment efficacy of refractory LPRD. Attention to and targeted treatment of anxiety and depressive symptoms can help improve the treatment outcomes of patients with refractory LPRD.”

This 2022 review in Cureus, Correlation of Anxiety and Depression to the Development of Gastroesophageal Disease in the Younger Population, concluded "This review revealed that subjects with gastroesophageal reflux disease have higher levels of anxiety and depression. When compared with various pieces of research, it is clear that conditions such as acid reflux, anxiety, and depression play a negative impact on the quality of life of these individuals."

From Translational Psychiatry in 2023, Depression and 24 gastrointestinal diseases: a Mendelian randomization study

“genetic liability to depression was associated with increased risks of 12 gastrointestinal disease outcomes “

“genetic liability to depression was associated with an increased risk of irritable bowel syndrome, non-alcohol fatty liver disease, alcoholic liver disease, gastroesophageal reflux “

From this 2024 paper in Scientific Reports, "Prevalence and associated factors of worry for cancer in patients with a Barrett’s esophagus":

"A significant group of BE patients reported high cancer worry which was associated with reflux symptoms in NDBE patients and a younger age, and a (family) history of the diagnosis esophageal carcinoma in BE patients treated for (early) neoplasia. Physicians should communicate about the actual cancer risk unambiguously, which leads to greater patient understanding and may therefore positively affects health outcomes."

Another paper in Scientific Reports in 2024, "Analyzing the correlation between gastroesophageal reflux disease and anxiety and depression based on ordered logistic regression" concludes: "there is a certain correlation between GERD and anxiety and depression, which provides theoretical references for individuals and clinical workers to focus on patients' psychological emotions when treating GERD."

Page updated 20 March 2024