Esophageal hypervigilance and symptom-specific anxiety as key determinants of symptom severity: a prospective study with manometry and pH metrics

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BACKGROUND: Esophageal hypervigilance and symptom-specific anxiety are emerging as key factors influencing symptom severity in patients with dysphagia and gastro-esophageal reflux disease (GERD). We aimed to evaluate the relative contributions of esophageal hypervigilance, alongside parameters of high-resolution manometry (HRM) and pH study, to esophageal symptom severity. METHODS: Consecutive patients attending HRM with or without a 24-hour pH study at a tertiary referral center were prospectively included from March 2022 to June 2024. Patients completed the following questionnaires: Esophageal Hypervigilance and Anxiety Scale (EHAS-7), Brief Esophageal Dysphagia Questionnaire, and Gastroesophageal Reflux Disease Questionnaire (GERDQ). Pearson's correlation was used to determine the interrelationships between questionnaire results, HRM, and pH study metrics. RESULTS: A total of 380 patients were included (median age 54; 63.2% female), with 226 undergoing pH studies. EHAS-7 showed stronger correlations with dysphagia symptom severity compared with manometry metrics in patients with normal manometry findings ( r = 0.306, P < 0.001), achalasia ( r = 0.429, P < 0.050), absent contractility and ineffective esophageal motility ( r = 0.611, P < 0.001), and distal esophageal spasm and hypercontractile esophagus ( r = 0.536, P = 0.048). Regression analysis showed EHAS-7 independently explained 14.1% of variance ( β = 0.382, P < 0.001) in dysphagia severity. In the pH study cohort, both EHAS-7 and pH study metrics had either weak or no correlations with the severity of patients' GERD symptoms. CONCLUSION: Esophageal hypervigilance and symptom-specific anxiety correlate more strongly with dysphagia symptom severity than HRM metrics in select patient groups, emphasizing its role in symptom perception.

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