Associations of Anxiety, Depression, and Sleep Quality with MNBI, PSPW-I, and ECJ-CI in rGERD, FH, and RH Patients: A Retrospective Study

ObjectiveThis study examined the impact of anxiety, depression, and sleep quality on mean nocturnal baseline impedance (MNBI), post-reflux swallow-induced peristaltic wave index (PSPW-I), and esophagogastric junction contractile index (EGJ- CI) in patients with refractory gastro-esophageal reflux disease (rGERD), functional heartburn (FH), and reflux hypersensitivity (RH). MethodsRetrospective analysis included 75 patients aged 18-70 with persistent reflux symptoms despite 8 weeks of proton pump inhibitor (PPI) therapy. Evaluations included esophagogastroduodenoscopy, high-resolution manometry, 24-hour pH- impedance monitoring, and psychological assessments (SAS, SDS, PSQI). Patients were grouped into rGERD, FH, and RH. MNBI, PSPW-I, and EGJ-CI were compared, and correlations with psychological and sleep parameters were analyzed. ResultsDistal MNBI was significantly lower in rGERD (1177.91 {+/-} 707.22 {Omega}) vs. FH (1995.77 {+/-} 476.02 {Omega}) and RH (2062.35 {+/-} 509.93 {Omega}) (P < 0.001). Anxiety prevalence was 85.7% in rGERD, 64.7% in FH, and 67.5% in RH (P = 0.302); depression affected 78.6% of rGERD, 70.8% of FH, and 72.9% of RH patients (P = 0.942). Poor sleep quality was present in >80% of all groups. PSPW-I negatively correlated with anxiety (r = -0.181, P < 0.05) and depression (r = -0.158, P < 0.05), as did proximal MNBI with depression (r = -0.175, P < 0.05). A distal MNBI cutoff of 1531 {Omega} distinguished rGERD from FH/RH with 71.4% sensitivity and 87.5% specificity (AUC = 0.80). ConclusionAnxiety, depression, and poor sleep quality impair PPI efficacy and worsen esophageal acid clearance. Distal MNBI effectively differentiates rGERD from FH/RH. Addressing psychological and sleep disturbances may improve treatment outcomes in refractory reflux patients.