Psychosocial factors and their association with reflux oesophagitis, Barrett’s oesophagus and oesophageal adenocarcinoma

• DOI: 10.3748/wjg.v19.i11.1770
• Publication Date: 2013-03-22T03:17:14Z
• Authors: Paul Denver
• Keywords: Male; Esophageal Neoplasms; Repression, Psychology; 610; Adenocarcinoma; RC0254; Barrett Esophagus; 03 medical and health sciences; Reflux oesophagitis; 0302 clinical medicine; SDG 3 - Good Health and Well-being; Risk Factors; Odds Ratio; Humans; Esophagitis, Peptic; Life Style; Aged; Retrospective Studies; Chi-Square Distribution; RC0254 Neoplasms. Tumors. Oncology (including Cancer); Depression; Gastroenterology; /dk/atira/pure/subjectarea/asjc/2700/2715; Middle Aged; Prognosis; Barrett's oesophagus; 3. Good health; Logistic Models; Adjustment; name=Gastroenterology; Oesophageal adenocarcinoma; Psychosocial factors; Multivariate Analysis; Psychological; Female; Ireland

To investigate the role of psychological characteristics as risk factors for oesophageal adenocarcinoma (OAC), as well as the reflux-mediated precursor pathway.An all-Ireland population-based case-control study recruited 230 reflux oesophagitis (RO), 224 Barrett's oesophagus (BO) and 227 OAC patients and 260 controls. Each case/control group completed measures of stress, depression, self-efficacy, self-esteem, repression and social support. A comparative analysis was undertaken using polytomous logistic regression adjusted for potential confounders.Compared to controls, OAC patients were almost half as likely to report high stress levels over their lifetime (P = 0.010, OR 0.51; 95%CI: 0.29-0.90) and 36% less likely to report having experienced depression (OR 0.64; 95%CI: 0.42-0.98). RO patients reported significantly higher stress than controls particularly during middle- and senior-years (P for trends < 0.001). RO patients were 37% less likely to report having been highly emotionally repressed (OR 0.63; 95%CI: 0.41-0.95). All case groups (OAC, RO and BO) were more likely than controls to report having had substantial amounts of social support (OR 2.84; 95%CI: 1.63-4.97; OR 1.97; 95%CI: 1.13-3.44 and OR 1.83; 95%CI: 1.03-3.24, respectively).The improved psychological profile of OAC patients may be explained by response shift. The role of psychological factors in the development of OAC requires further investigation.