ORIGINAL RESEARCH article
Front. Med.
Sec. Gastroenterology
Somatic Symptom Disorder in Gastroesophageal Reflux Disease: A Key Factor Contributing to Severe Symptoms and Impaired Quality of Life
YA JIANG
Li Gao
Weichen Liu
Yurong Tang
First Affiliated Hospital, Nanjing Medical University, Nanjing, China
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Abstract
Background: Somatic symptom disorder (SSD) is a common yet frequently overlooked comorbidity in patients with gastroesophageal reflux disease (GERD), compromising quality of life (QOL) and increasing healthcare utilization. Aims: This study aimed to evaluate its impacts of SSD on symptom perception and QOL and to determine the risk factors for SSD in GERD patients. Methods: A cross-sectional study was conducted in a tertiary gastroenterology department. 209 GERD patients completed validated questionnaires assessing reflux symptoms, somatic symptoms, anxiety, depression, sleep quality, and QOL. SSD was diagnosed based on DSM-5 criteria. All patients underwent upper endoscopy and a subset completed esophageal manometry and 24-h pH-impedance monitoring investigations. Results: The proportion of SSD was 30.14% (63/209). Despite having milder objective reflux burden on 24-h pH-impedance monitoring and esophageal manometry, patients with SSD reported higher reflux symptom scores [GerdQ: 9(5) vs. 8(4), p=0.032; RSI: 12(9) vs. 4(6), p<0.001], more severe anxiety and depression, worse sleep quality (all p<0.001), and lower QOL [GIQLI: 94(37) vs. 121(27.5), p<0.001] than non-SSD patients. Female gender, laryngopharyngeal reflux symptoms, anxiety, and depression were independent risk factors for SSD. SSD partially mediated the negative impacts of reflux symptoms and poor sleep on QOL (23.52% for GerdQ, 26.30% for RSI and 14.05% for PSQI). The PHQ-15 demonstrated high accuracy (AUC=0.851) in identifying comorbid anxiety/depression with sleep disturbances at a cutoff score of 12.5. Conclusion: SSD aggravates GERD symptoms and mediates impaired QOL by reflux and sleep disturbance. Screening SSD with PHQ-15 is recommended, particularly in females and those with laryngopharyngeal reflux symptoms.
Summary
Keywords
Gastroesophageal reflux disease, psychological distress, Quality of Life, screening, Somatic symptom disorder
Received
07 December 2025
Accepted
09 February 2026
Copyright
© 2026 JIANG, Gao, Liu and Tang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Yurong Tang
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