Published online Jun 26, 2019. doi: 10.12998/wjcc.v7.i12.1421
Peer-review started: January 3, 2019
First decision: January 30, 2019
Revised: April 22, 2019
Accepted: May 2, 2019
Article in press: May 2, 2019
Published online: June 26, 2019
Gastro-esophageal reflux disease (GERD) is a common and serious health problem leading to a decrease in the quality of life of patients. The concept of health-related quality of life (HRQL) covers an expanded effect of the disease on a patient’s wellbeing and daily activities. This study evaluates the effect of GERD symptoms and factors that cause decrease in quality of life, such as stress level, age and body weight.
Since GERD leads to a considerable decrease in the quality of life, we conducted an observational study to assess the importance of its impact on the eight domains of life (physical functioning (PF), role limitations due to physical problems, bodily pain (BP), general health perceptions, vitality (Vt), social functioning, role limitations due to emotional problems and mental health perceptions) measured in a generic questionnaire. Moreover, we evaluated the importance of stress, excessive weight and age on the above-mentioned domains.
The research objective was to determine the independent effect of reflux symptoms, age, stress and increasing body mass index (BMI) on the quality of life of patients using the SF-36 questionnaire.
A total of 118 patients diagnosed with reflux disease who reported to an outpatient department of gastroenterology or a specialist hospital ward for planned diagnostic tests were recruited. Assessment of the level of reflux was based on five typical GERD symptoms, HRQL was measured by a 36-item Short Form Health Survey and level of stress using the 10-item Perceived Stress Scale. Multi-variable relationships were analyzed using multiple regression. The results of our study were compared with the results obtained in a random sample of 8801 inhabitants of Great Britain drawn from General Practitioner Records held by the Health Authorities for Berkshire, Buckinghamshire, Northamptonshire, and Oxfordshire and the subpopulation of chronically ill patients in this sample.
In the examined population, the frequency of reflux symptoms resulted in a decrease in patients’ results according to six out of eight SF-36 scales-except for mental health and Vt scales. Stress resulted in a decrease in patient function in all domains measured using the SF-36. Age resulted in a decrease in PF and in an overall assessment of self-reported state of health. An increasing BMI exerted a negative effect on physical fitness and limitations in functioning resulting from this decrease. When compared to the GBS group, patients from our study showed a lower quality of life in all eight life domains. In turn, compared to the GBS-longstanding illness group, they did not significantly differ according to the PF and Vt scales. The largest difference between the quality of the assessed domains was observed for BP, which in the Lublin population occupied the lowest position, lower by 30 scores than in GB sample.
The level of HRQL in GERD patients is negatively determined by both the frequency of reflux symptoms and, to an even higher degree, by stress. An increasing BMI, irrespective of reflux symptoms, stress, and age, decreases the level of PF of GERD patients. It also leads to an increase in limitations in functioning ascribed to emotional disorders. The patient’s stress level should be considered in the diagnosis and therapy, as well as in the assessment of treatment progress.
In our study, the stress level reported by the patient turned out to be more important for HRQL than the severity of gastroesophageal reflux disease. Future studies assessing the impact of diseases on HRQL should take into account factors that are not symptoms of the disease. Moreover, in assessing the effectiveness of treatment, we should take into account the impro-vement of HRQL as well as the reduction of disease-related symptoms.