{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:14:42Z","timestamp":1783037682519,"version":"3.54.6"},"reference-count":49,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2023,2,14]],"date-time":"2023-02-14T00:00:00Z","timestamp":1676332800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Anxiety may exacerbate GERD and FD symptoms perception and reduce quality of life. As many as 50% of patients with GERD symptoms have incomplete relief with PPI therapy, and psychological factors may influence PPI responsiveness.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>The potential relationship between anxiety, excessive air swallowing, and PPI responsiveness was evaluated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>GERD patients with concomitant FD were prospectively evaluated. Validated structured questionnaires were used to evaluate anxiety, GERD, and FD symptoms. All patients were treated, within the previous year, with at least 8\u2009weeks of standard dose PPI therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>One hundred sixty\u2010one patients were included. Frequency of non\u2010responders in patients with moderate\/severe anxiety was significantly higher compared to patients with mild anxiety (62.7% vs. 37.3%, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01). Patients with moderate\/severe anxiety displayed a significantly higher mean FD symptoms score value compared to patients with mild anxiety. A significantly higher mean number of air swallows were observed in patients with moderate\/severe anxiety. At ROC analysis, air swallows and mixed reflux episodes were significantly associated with the presence of PPI refractoriness (AUC: 0.725, 95% CI: 0.645\u20130.805 and 0.768, 0.692\u20130.843). According to univariate analysis, an abnormal number of air swallows, mixed reflux episodes and presence of moderate\/severe anxiety was significantly associated with PPI refractoriness.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our results, if confirmed in in a larger, prospective clinical and therapeutic study, demonstrate the usefulness of an up\u2010front evaluation with anxiety questionnaire and esophageal testing in patients with a broad spectrum of upper gastrointestinal symptoms who fail to respond to PPI treatment, supporting the option of alternative treatment modalities.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nmo.14550","type":"journal-article","created":{"date-parts":[[2023,2,14]],"date-time":"2023-02-14T09:27:24Z","timestamp":1676366844000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Anxiety correlates with excessive air swallowing and PPI refractoriness in patients 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