Investigation of pretreatment prediction of proton pump inhibitor (PPI)-resistant patients with gastroesophageal reflux disease and the dose escalation challenge of PPIs��TORNADO study: a multicenter prospective study by the Acid-Related Symptom Research Group in Japan

Backgrounds

Some non-erosive reflux disease (NERD) and reflux esophagitis (RE) patients are unresponsive to a proton pump inhibitor (PPI) at standard dose. We investigated the predictive marker of the efficacy of PPI for GERD patients including NERD and RE treated with standard and increased doses of a PPI.

Methods

Patients with symptomatic gastroesophageal reflux disease (GERD) (NERD and RE) were treated with rabeprazole (RPZ) 10?mg once daily for 4?weeks. The RPZ dosage was increased to 10?mg twice daily for an additional 2?weeks and again to 20?mg twice daily for another 2?weeks if heartburn was not relieved. Baseline characteristics and efficacy of RPZ were assessed on the basis of a heartburn diary and frequency scale for symptoms of GERD (FSSG).

Results

Complete heartburn relief rates after 4?weeks were 42.5% (31/73) and 67.9% (19/28) in NERD and RE groups, respectively, which rose to 68.9 and 91.7% after dose escalation. Multivariate analysis revealed that parameters associated with resistance to RPZ 10?mg once daily were female, non-smoking, frequent heartburn, low score for question 4 (Q4) of the FSSG (subconsciously rubbing the chest), and high scores for Q3 (heavy stomach after meal) and Q7 (unusual sensation in the throat). Frequent heartburn and a high score for Q7 were associated with resistance to RPZ 20?mg twice daily. FSSG scores of patients resistant to RPZ were significantly higher in comparison with responders before and during treatment.

Conclusions

FSSG could predict response to a PPI for symptomatic GERD. Increase of RPZ dose is useful for treatment of GERD refractory to the standard dose of RPZ.     

Treatment of uncomplicated reflux disease

Uncomplicated reflux disease comprises the non-erosive reflux disease (NERD) and erosive reflux disease (ERD). The objectives of treatment are the adequate control of symptoms with restoration of quality of life, healing of lesions and prevention of relapse. Treatment of NERD consists in the administration of proton pump inhibitors (PPI) for 2-4 wk, although patients with NERD show an overall poorer response to PPI treatment than patients with ERD owing to the fact that patients with NERD do not form a pathophysiologically homogenous group. For long-term management on-demand treatment with a PPI is probably the best option. In patients with ERD, therapy with a standard dose PPI for 4-8 wk is always recommended. Long-term treatment of ERD is applied either intermittently or as continuous maintenance treatment with an attempt to reduce the daily dosage of the PPI (step-down principle). In selected patients requiring long-term PPI treatment, antireflux surgery is an alternative option. In patients with troublesome reflux symptoms and without alarming features empirical PPI therapy is another option for initial management. Therapy should be withdrawn after initial success. In the case of relapse, the long-term care depends on a careful risk assessment and the response to PPI therapy.     

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目的探讨非糜烂性胃食管反流病不同于反流性食管炎的发病机制。方法选择1996～2004年北京大学人民医院因反酸、胃灼热感等反流症状确诊为胃食管反流病患者57例,按照内镜下食管黏膜有无破损分为非糜烂性胃食管反流病组和反流性食管炎组,比较两组的一般情况、反流症状、是否合并H.pylori(Hp)感染,以及食管动力测定和食管胃24hpH监测结果。结果两组患者年龄、性别、烟酒嗜好等一般情况及合并Hp感染情况比较差异无显著性。非糜烂性胃食管反流病组不典型反流症状(胸骨后痛)的发生率明显高于反流性食管炎组。两组患者都存在病理性酸反流,但两组患者之间酸和(或)碱反流比较无差异。非糜烂性胃食管反流病患者的食管体部各段蠕动波峰值明显高于反流性食管炎患者。非糜烂性胃食管反流病患者卧位胃酸分泌高于反流性食管炎患者。结论非糜烂性胃食管反流病的不典型反流症状发生率更高。在两组发病机制异同上,反流的强弱并非主要因素,重要的是食管防御机制的差别。     

反流性食管炎和非糜烂性反流病患者症状谱、生活质量和精神心理状态调查

背景：胃食管反流病（GERD）包括非糜烂性反流病（NERD）、反流性食管炎（RE）和Barrett食管（BE），其发病机制可能有所不同。目的：分析比较NERD和RE患者的人口学特征和临床特点，为探讨其发病机制和有效治疗提供依据。方法：对连续入组的278例GERD患者进行问卷调查，内容包括一般人口学资料、胃食管反流以及相关症状评分、食管外症状、重叠症状、生活质量评价和精神心理状态评价。结果：NERD和RE分别占GERD的60．8％和37．1％；与RE组相比，NERD患者以女性多见（P〈0．05），平均年龄较轻（R〈0．05）。胃食管反流症状评分在两组患者间无显著差异，但RE组烧心频率较NERD组高（P〈0．05），而NERD组胸骨后疼痛更突出，反食症状较轻。两组患者的食管外症状、重叠症状发生率无显著差异。NERD组患者生活质量下降更明显。NERD组患者合并精神心理异常的比例显著高于RE组（P〈0．05），且抑郁评分高。结论：本组资料中大部分GERD患者为NERD，NERD和RE的反流以及相关症状谱无显著差异。但NERD患者常合并精神心理异常、生活质量下降，提示精神心理因素在NERD的发病中可能起重要作用。     

Barrett食管、反流性食管炎和非糜烂性胃食管反流病的反流物特点

目的应用食管24 h pH-阻抗(MII-pH)等检查方法,分析具有胃食管反流病(GERD)典型症状、并且食管MII-pH检查结果异常的GERD患者,比较分析其各亚型,即Barrett食管(BE)、反流性食管炎(RE)和非糜烂性胃食管反流病(NERD)患者的胃食管反流特点。 方法入选具有典型胃食管反流症状(烧心/反流),并且食管24 h MII-pH检查结果异常的GERD患者,根据内镜检查结果分为BE、RE、NERD三组,收集患者24 h的食管pH-阻抗信息,应用SPSS16.0统计软件进行组间Mann Whitney检验、多因素方差分析,P< 0.05认为具有统计学差异。 结果共入组103例具有典型反流症状且MII-pH监测阳性的GERD患者,其中有15例BE患者、32例RE患者、56例NERD患者。三组患者的平均年龄、性别构成、以及BMI无显著差异性。将三组患者的各项胃食管反流指标数值进行Mann-Whitney检验,显示RE、BE患者的DeMeester评分、pH<4反流时间百分比、长反流周期数显著高于NERD患者,具有显著性差异。BE患者的反流周期数显著多于RE和NERD患者,具有显著性差异。阻抗相关指标在三组患者之间均没有统计学差异。 结论与NERD相比,酸反流对于RE和BE具有更重要的致病意义。     

反流性食管炎和非糜烂性反流病患者酸暴露与食管压力监测结果分析

目的通过对胃食管反流病（GERD）患者的酸暴露情况、食管下括约肌（LES）压力、食管体部压力、幽门螺杆菌（Hp）感染结果的比较，探讨反流性食管炎（RE）、非糜烂性反流病（NERD）的不同状况，为临床治疗提供科学依据。方法2001年10月至2005年7月，具有反流症状（烧心、反酸）的患者80例，胃镜检出RE31例，NERD45例，Barrett食管（BE）4例。行食管24hpH动态监测，并以De—Meester积分均值将GERD分为轻、中、重度，检测LES、食管体部即LES上方5cm、7cm、13cm（简记为L5、L7、L12）和食管上括约肌（UES）下方1cm、6cm、8cm（简记为U1、U6、U8）压力指标，并进行Hp感染的检查。结果RE、NERD两组患者食管24hpH酸暴露各指标的差异，无统计学意义（P〉0．05），De-Meester积分均值亦无统计学意义（P〉0．05）；轻、中、重度GERD患者食管24hpH监测指标具有统计学意义（P〈0．01）。RE、NERD两组患者LES压力、食管体部的L5、L7、L12、U6和u8压力监测指标无统计学意义（P〉0．05），只有RE组U1压力低于NERD组，差异有统计学意义（P〈0．05）；轻、中、重度GERD患者LES压力和食管体部的压力监测指标差异无统计学意义（P〉0．05）。RE和NERD组患者Hp感染率分别为16．1％和22．2％，其差异无统计学意义（P〉0．05），OR为1．309，95％C10．364～4．705。结论RE和NERD患者酸暴露、LES压力和食管体部压力等相应指标无明显差异；NERD在发病机制中，酸反流的强弱没有起到决定性作用。     

Pathophysiology, diagnosis and treatment of non-erosive reflux disease (NERD)

Up to 70% of patients with typical symptoms of gastroesophageal reflux disease (GERD) have neither definite endoscopic oesophageal breaks nor Barrett's oesophagus at upper endoscopy. These patients suffer from non-erosive reflux disease (NERD), also termed endoscopy-negative reflux disease or symptomatic GERD. NERD patients appear as a heterogeneous population with multiple and substantially different mechanisms implicated in the genesis of symptoms. In fact, patients with NERD may be divided into 3 groups on the basis of 24-hour pH monitoring: 1) patients with an abnormal acid exposure time (AET); 2) patients who demonstrate a normal AET, but in whom symptoms and reflux events are significantly correlated (hypersensitive oesophagus) and 3) patients with typical reflux symptoms but in whom all parameters of the pH study are normal. There is no gold standard for the diagnosis of NERD but a well-taken history can be, usually, sufficient to confirm the diagnosis and begin therapy. Thus, the more sensitive tool for the diagnosis of NERD is proton pump-inhibitor (PPI) test. The aims of NERD treatment are: symptoms relieve, restore quality of life and maintain clinical remission. Proton pump-inhibitors (PPIs) in full doses represent the treatment of choice of NERD patients, even if overall, clinical trials showed a lower efficacy in symptoms control when compared to patients with erosive oesophagitis. Patients with NERD often need long-term therapy for symptoms control. 'On demand' PPI therapy has been considered as the most cost-effective strategy for the long-term treatment of NERD. In conclusion, many data indicate that NERD is a disorder in its own right that shares symptoms with other GERD groups. However further studies are needed to better define the natural history and improve the treatment of this disorder.     

Gastro-esophageal reflux disease: the recent trend in Japan

Gastro-esophageal reflux disease (GERD) has increased in Japan, as in other countries. This is probably due to increased acid secretion among Japanese due to Westernized foods and lifestyle as well as decreased prevalence of Helicobacter pylori infection. Proton pump inhibitor (PPI) is mainly used for treatment of this condition. PPI has recently been approved for treatment of nonerosive reflux disease (NERD) in Japan. NERD is known to have different characteristics to GERD, and effectiveness of PPI in NERD patients is lower than that in reflux esophagitis patients. Regarding therapeutic benefit of treatment, a recent study showed that PPI improved quality of life (QOL) of GERD patients also in Japan. For diagnosis of reflux esophagitis in Japan, we use a unique classification, a modified Los Angeles (LA) classification, which includes minimal change (grade M esophagitis) as one distinct criteria. However, recent studies from Japan showed poor interobserver agreement in diagnosis of grade M, although excess acid reflux in minimal change was shown in another study. Our definition of Barrett’s esophagus is also different from that in the West. Nationwide consensus on diagnosis of reflux esophagitis and Barrett’s esophagus should be achieved in Japan, preferably consistent with world standard.     

Gastroesophageal reflux disease

GERD is a common chronic gastrointestinal disorder, and its prevalence in Asia is increasing. Classical symptoms of heartburn and regurgitation are common presentations. There is no standard criterion for the diagnosis of GERD, and 24-h pH monitoring lacks sensitivity in NERD. Furthermore, diagnostic studies for gastroesophageal reflux disease have several limitations. A short course of PPI is often used in clinical practice as a diagnostic test for gastroesophageal reflux disease. Elderly patients with GERD usually present with atypical manifestations, and they tend to develop more severe disease. PPI remains the mainstay of treatment for GERD. In a subset of patients who wish to discontinue maintenance treatment, anti-reflux surgery is a therapeutic option.     

反流性食管炎与非糜烂性反流病食管酸暴露的特点比较

目的　比较反流性食管炎 (RE)与非糜烂性反流病 (NERD)各亚组食管酸暴露特点。方法　具有典型反酸 烧心等症状的 12 8例患者 ,经胃镜等系统检查诊断为胃食管反流病 (GERD)。便携式 pH监测仪行胃食管 2 4hpH监测 ,DeMeester积分≥ 15分为存在病理性酸反流。 结果　 12 8例患者中 ,37例 (2 8 9% )存在RE ,91例 (71 1% )为NERD。pH监测阳性在RE组和NERD组中分别为 2 5例 (6 7 6 % )和 4 6例 (5 0 5 % ) ,差异无统计学意义 ;两组DeMeester积分均值差异亦无统计学意义 (5 3 4 5± 6 2 0 4比 4 0 0 4± 6 1 80 ,P >0 0 5 )。RE组长反流次数显著高于NERD组 (8 16±10 2 7比 3 96± 6 87,P =0 0 0 4 )。以症状指数 >5 0 %为阳性 ,NERD阳性组 (pH值监测异常 )症状指数阳性率显著高于NERD阴性组 (pH值监测正常 ) (43 5 %比 15 6 % ,P <0 0 0 1)。NERD阴性组中具有阳性症状指数的患者 7例 (15 6 % ) ,阴性症状指数者 38例。前者总反流次数及立位反流时间百分比显著高于后者。RE患者中 ,12例 pH监测阴性者食管及胃内pH的中位值显著高于 pH监测阳性者。结论　RE患者长反流发生率高于NERD患者 ;症状的发生与酸反流相关 ;NERD患者根据酸反流与症状关系可分为不同的亚组。RE阴性组可能存在混合反流或胆汁反流     

非糜烂性反流病患者食管黏膜SP和CGRP的表达

目的 观察非糜烂性反流病(NERD)和反流性食管炎(RE)患者食管黏膜内P物质(SP)和降钙素基因相关肽(CGRP)免疫反应阳性产物的表达,探讨其在NERD发病中的作用.方法 选择有典型胃食管反流症状并经反流性疾病诊断问卷(RDQ)调查、PPI试验、胃镜检查及食管24h pH检测诊断为GERD患者51例,其中RE组21例,NERD酸反流阳性组(NERD+组)12例,NERD酸反流阴性组(NERD-组)18例,采用免疫组化方法 在显微镜下观察NERD、RE患者食管黏膜内SP、CGRP的表达,应用彩色病理图像分析软件,分析计算SP、CGRP免疫反应的阳性指数(PI),并与正常对照组10例比较.结果 NERD-组食管黏膜内SP、CGRP的Pl值为96.77±31.74和24.76±29.15,明显高于NERD+组(73.64±31.38、9.78±10.30)、RE组(67.56±34.62、9.61±6.20)及正常对照组(59.82±46.15、8.64±12.12)(P均<0.05).结论 SP、CGRP在NERD-的患者食管黏膜内有明显表达,可能在食管内脏感觉中发挥着重要的作用.     

胃食管反流病食管外表现的临床研究

目的探讨胃食管反流病（GERD）食管外表现（EED）的临床特征和质子泵抑制剂对EED的治疗效果。方法本研究为多中心、开放、前瞻性临床研究,在上海市的4家医院同期入选GERD患者,均符合内镜下有反流性食管炎（RE）的诊断标准,无RE者则为24h食管pH监测阳性的非糜烂性反流病（NERD）。进行GERD典型症状和EED相关症状的问卷调查并记录积分,有EED症状者行电子喉镜检查并记录有关征象,然后对上述资料进行统计、比较分析。结果共分析200例符合标准的GERD患者,伴有EED者95例,无EED者105例;NERD患者66例,RE134例,其中65例为具有EED的RE患者。EED的症状最常见的为咽球感和（或）咽部异物感,发生率为27％,其他常见的依次为咳嗽、咽喉灼痛、声音嘶哑,哮喘较少,其发生率分别为21％、16％、11％、3％。有EED的患者中并存典型GERD症状的发生率为56％,EED症状的严重程度在RE和NERD患者间差异无统计学意义。喉镜检查示声带红斑、水肿32％,杓区红肿25％,咽后壁淋巴增生20％,未见明显异常的42％。95％的EED患者治疗8周后症状基本消失。结论较大比例的GERD患者中有EED存在,而喉镜、常规24hpH监测对诊断的阳性预测值不高,高剂量质子泵抑制剂对EED的治疗有效。     

轻度反流性食管炎与非糜烂性反流病远端食管酸暴露和食管动力学变化

目的:探讨轻度反流性食管炎(RE)与非糜烂性反流病(NERD)食管远端酸暴露及食管动力变化特点.方法:符合洛杉矶诊断标准的RE30例(LA-A16例,LA-B14例),NERD16例,健康对照组10例被纳入本研究,所有患者及对照组均接受24h食管pH监测及压力测定,比较食管pH监测及测压结果.结果:LA-A组、LA-B组、NERD组DeMeester评分明显高于对照组,差异显著(P<0.05).LA-A组与NERD组比较DeMeester评分无明显差异,但NERD组的立位反流时间百分比与长反流周期数多于LA-A组,差异显著;LA-B组DeMeester评分比LA-A组和NERD组明显增高,LA-B组与LA-A组比较食管pH监测各项指标均存在明显差异.LA-A组、NERD组及对照组比较下食管括约肌静息压(LESP)、食管体部蠕动波幅度(PA)无显著差异,LA-A组和NERD组食管下段PA有增高趋势;LA-B组与LA-A组、NERD组及对照组比较LESP明显降低(P<0.05),LA-B组食管下段PA明显低于LA-A组(P<0.05).RE组无效食管运动(IEM)明显高于对照组,差异显著.结论:轻度RE(LA-B)与NERD远端食管酸暴露存在差异.DeMeester评分、LES功能不全及食管蠕动功能障碍与RE的严重程度呈正相关.LES功能不全及食管蠕动功能障碍可能不是轻度RE(LA-A)及NERD的主要致病因素.IEM与RE关系密切,且与RE有关的食管动力异常主要为IEM.     

食管运动功能在重度反流性食管炎中的地位

目的　通过对重度反流性食管炎(RE)治愈前后食管体部运动功能的研究,了解食管体部运动功能在重度RE中的地位。方法　对70例胃食管反流病患者进行食管压力测定。从中筛选23例重度RE(内镜诊断为洛杉矶C和D级食管炎);且24h食管内pH监测证实为病理性酸反流;食管压力测定证实有食管体部运动障碍患者。给予兰索拉唑30mg/d治疗3~6个月至内镜下食管炎完全愈合后,再行食管压力测定,观察下食管括约肌静息压(LESP)及食管体部运动功能的变化。以湿咽成功率、食管远端收缩波幅和食管蠕动的传导速度作为食管体部运动功能的指标。结果　食管炎治愈前后,LESP[ (6 00±0 86 )mmHg比(5 10±0 87)mmHg, 1kPa=7 5mmHg, P=0 476],食管远端收缩波幅[ (34 1±4 1)mmHg比(37 2±4 0)mmHg,P=0 593]、湿咽成功率[ (33 5±6 5)%比(38 6±7 1 )%,P=0 592 ]比较差异均无统计学意义,其均值仍显著低于正常对照组。结论　治愈食管炎并不能提高LESP及改善食管体部的运动功能。食管体部运动功能障碍和酸反流是RE的重要发病机制,尤其是重度RE。     

雷贝拉唑对胃食管反流病患者生活质量的影响

目的比较反流性食管炎(RE)和非糜烂性胃食管反流病(NERD)患者在雷贝拉唑治疗后生活质量的变化。方法2002年12月至2003年6月在国内进行了多中心观察雷贝拉唑(10mg,每天2次口服)8周治疗RE和NERD患者的疗效。共入选RE患者74例和NERD患者37例。治疗前后采用问卷调查方式了解生活质量,问卷包括胃食管反流病-生活质量问卷量表(GERD-HRQL)和SF-36健康量表。结果(1)治疗后所有患者症状改善均为显效,RE患者糜烂愈合率达94.6%。(2)RE患者在SF-36健康量表中7个维度有明显改善,与治疗前比较差异有统计学意义(P<0.05)。NERD患者仅在总体健康和活力2个维度有明显改善(P<0.05)。(3)RE和NERD两组比较,治疗前在SF-36健康量表中NERD患者在活力、躯体疼痛和总体健康3个维度上低于RE患者;治疗后RE患者6个维度值高于NERD患者(P<0.05),GERD-HRQL评分也明显低于NERD组。结论有效抑酸治疗可以理想地控制GERD患者的症状,但是NERD患者生活质量的改善不如RE患者,说明NERD患者的发病是多因素的,在治疗上更应强调综合整体治疗。     

Rikkunshito improves symptoms in PPI-refractory GERD patients: a prospective, randomized, multicenter trial in Japan

Background

To seek a promising therapeutic regimen for proton pump inhibitor (PPI)-refractory patients with gastroesophageal reflux disease (GERD) after the standard PPI treatment, we compared the efficacies of rikkunshito (a Japanese traditional medication) combined with rabeprazole (RPZ) and a double dose of RPZ in a prospective randomized multicenter trial in Japanese PPI-refractory GERD patients.

Methods

One hundred and four patients with GERD symptoms remaining after 4-week treatment with RPZ (10?mg/day) were randomly assigned to 4?weeks of either combination therapy [rikkunshito (7.5?g/day) with a standard dose of RPZ (10?mg/day)] or a double dose of RPZ (20?mg/day). The primary endpoint was the improvement rate, calculated based on the frequency scale for the symptoms of GERD (FSSG) before and after treatment. Subgroup analysis was also performed with respect to each subject??s background factors such as reflux esophagitis (RE)/non-erosive GERD (NERD), age, gender, and body mass index (BMI).

Results

Four-week treatment with rikkunshito combined with RPZ significantly decreased the FSSG score from 17.6?±?6.5 to 12.0?±?6.9, similar to the decrease seen on treatment with a double dose of RPZ. Regarding the therapeutic improvement rate, there were also significant effects in both groups. However, in the subgroup analysis based on RE/NERD, the improvement rate of male NERD patients in the rikkunshito group was significantly greater than that of such patients in the other group (P?P?Conclusion Rikkunshito combined with standard-dose RPZ therapy may be a useful new strategy for PPI-refractory GERD patients.     

The prokinetic effect of mosapride citrate combined with omeprazole therapy improves clinical symptoms and gastric emptying in PPI-resistant NERD patients with delayed gastric emptying

Background  

Previous studies have shown that non-erosive reflux disease (NERD) patients are less sensitive to proton pump inhibitor (PPI) treatment than patients with erosive reflux disease. The aim of this study was to investigate whether treatment with prokinetics in addition to omeprazole therapy would improve clinical symptoms, gastric emptying and esophageal peristalsis in PPI-resistant NERD patients with or without delayed gastric emptying.     

Washed microbiota transplantation reduces proton pump inhibitor dependency in nonerosive reflux disease

BACKGROUND The pathogenesis of gastroesophageal reflux disease(GERD)is closely associated with the intestinal bacteria composition and their metabolites.AIM To investigate whether washed microbiota transplantation(WMT)improves symptoms of nonerosive reflux disease(NERD)with proton pump inhibitor(PPI)dependency.METHODS Patients with recurrent NERD and PPI dependency at the First Affiliated Hospital of Guangdong Pharmaceutical University from 2017 to 2018 were included and divided into a WMT or PPI group treated with PPI with/without WMT.The endpoint was NERD symptom frequency evaluated 1 mo after WMT using reflux disease questionnaire(RDQ)and GERD questionnaire(GERDQ)scores,remission time,PPI dose,and the examination of intestinal mucosal barrier function.RESULTS In the WMT(n=15)and PPI(n=12)groups,the total remission rate at 1 mo after treatment was 93.3%vs 41.7%.Compared with the PPI group,the WMT group showed better results in GERDQ(P=0.004)and RDQ(P=0.003)and in remission months(8 vs 2,P=0.002).The PPI dose was reduced to some extent for 80%of patients in the WMT group and 33.3%in the PPI group.In 24 patients,intestinal mucosal barrier function was examined before treatment,and changes in the degree of damage were observed in 13 of these patients after treatment.Only one of the 15 patients had minor side effects,including a mushy stool two or three times a day,which resolved on their own after 1 wk.CONCLUSION This study is the first to demonstrate that WMT may be safe and effective for relieving NERD symptoms and reducing PPI dependency and recurrence.     

焦虑、抑郁及睡眠障碍与胃食管反流病的相关研究

ObjectiveTo analyze the mental abnormalities in patients with gastroesophageal reflux disease (GERD), and to explore the correlation between GERD and mental disorders. MethodsA total of 40 patients who diagnosed in our hospital from December 2017 to June 2018 were selected, then further divided into non erosive reflux disease (NERD) group and refluxive esophagitis (RE) group according to clinical manifestations, GERD questionnaire score and gastrointestinal endoscopy. Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD) and Pittsburgh sleep quality index (PSQI) were used in two groups. ResultsAccording to the analysis result of HAMA in the two groups, the anxiety scale of NERD group was significantly higher than that of RE group (P＜0.05);HAMD analysis shows that depression scale in NERD group was significantly higher that RE group (P＜0.05); PSQI analysis shows that sleep disorder scale in NERD group was significantly higher that RE group (P＜0.05); the correlation analysis of GerdQ score showed that anxiety, depression and sleep disorder were positively correlated with the severity of symptoms (P＜0.05). ConclusionThe depression, anxiety and sleep disorder in NERD patients is higher than that in RE group. The scale of anxiety, depression and sleep disorder is helpful to the psychological intervention and the choice of rational drug treatment in GERD patients with mental disorders.