Nan Zhang, Yi Wang, S Fang, Ming Han, Qin-Wei Zheng, Yingying Zhu, Mengyuan Zhang, Jingjing Li, Lin-Xuan Cui, Jinli Tian, Yu-Hai Deng, Zhu Sheng-liang, Hongmei Ni, Li Zhou, Guang-Liang Zuo, Tian-Sheng Huang, Qi Liao, Xiuqing Li, Ying-Ying Shang, Yongjun Wang, Yun Tian, Lili Ge, Haiqiong Han, Weimin Hu, Yi Jiang, Jun Li, Xiang Mao, Lihong Yang, Junmin Yao, Xin Zheng, Hongwei Wang, Sheng-Quan Fang
BACKGROUND: Refractory gastroesophageal reflux disease (GERD) constitutes a significant proportion of GERD cases and presents a considerable burden in clinical practice. However, the underlying risk factors contributing to persistent and refractory symptoms and the clinical characteristics of this disease remain poorly understood. AIM: To investigate the clinical features of refractory GERD and identify the associated risk factors. METHODS: This is a multicenter cross-sectional study on patients with GERD across 18 medical centers in Shanghai. All participants completed comprehensive questionnaires that assessed their demographic characteristics, lifestyle and dietary habits, clinical manifestations, somatic symptoms, mental and psychological health status, and quality of life. Univariate analysis was performed to identify significant differences between the patients with refractory and non-refractory GERD. Subsequently, stepwise regression analysis was employed to conduct a multivariate binary logistic regression for exploring the association between refractory GERD and various factors, including dietary habits, lifestyle, clinical symptoms, and mental and psychological status. RESULTS: Our study included 911 patients diagnosed with GERD, of whom 256 (28.1%) had refractory GERD and 655 (71.9%) had non-refractory GERD. Compared to patients with non-refractory GERD, those with refractory GERD are older, have a longer disease duration, and exhibit higher scores for typical reflux symptoms. They are also more likely to present with atypical symptoms, more prone to overeating, more likely to experience somatic symptoms, comorbid anxiety, and depression, and report a lower quality of life. Binary logistic regression analysis identified disease duration and anxiety as significant risk factors and at least 90 minutes of moderate-intensity physical activity per week as a protective factor for refractory GERD. CONCLUSION: Refractory GERD is associated with a prolonged disease duration, anxiety status, and insufficient physical activity. These findings may afford valuable insights for the clinical management and development of non-pharmacological interventions for refractory GERD.