臺灣博碩士論文加值系統

ABSTRACT
Background: Gastroesophageal reflux disease (GERD) is associated with depression and sleep quality of the patient, but the result of PPI treatment towards depression level and sleep quality remains unclear. The aim of this study is to examine the changes in depression level and sleep quality of GERD patients before and after PPI medication.
Material and methods: This was a prospective study that recruited 332 eligible GERD patients and was conducted from February 2016 to May 2018. All participants were evaluated using Reflux Disease Questionnaire score, Gastroesophageal Reflux Disease Questionnaire score, Taiwanese Depression Questionnaire and Pittsburgh Sleep Quality Index. The chi-square test was used to compare categorical variables and independent t-test was used to compare continuous variables. A paired t-test was used to compare the changes after PPI medication. Pearson correlation and hierarchical linear regression was used to estimate factor associated with change of depression and sleep quality in GERD patients during PPI therapy, separately.
Result: Reflux symptom was getting improved after PPI medication as depression was improved (p<0.001), while sleep quality was getting worse after PPI(p<0.001). The improvements of depression score was slightly associated with the change of reflux (β=0.08; 95% CI=-0.02to 0.20) and NERD patients (β =2.62; 95% CI=0.33to4.92). The improvement of sleep quality was slightly associated with GERD history from two to five years (β=0.90; 95% CI=0.08 to 1.89) while alcohol was negatively associated with the change of sleep quality score (β=-0.74; 95% CI=-1.47to-0.01). Baseline of reflux score was associated with baseline of depression (r=0.40) and sleep quality score(r=0.18).
Conclusion: Depression was getting improved while sleep quality was getting worse after taking PPI medication in GERD patients. The improvements of depression score was associated with NERD and slightly associated with the change of reflux. The change of sleep quality was slightly associated with GERD history from two to five years and alcohol was negatively associated. Baseline of reflux score was associated with baseline of depression and sleep quality score.

ABSTRACT
Background: Gastroesophageal reflux disease (GERD) is associated with depression and sleep quality of the patient, but the result of PPI treatment towards depression level and sleep quality remains unclear. The aim of this study is to examine the changes in depression level and sleep quality of GERD patients before and after PPI medication.
Material and methods: This was a prospective study that recruited 332 eligible GERD patients and was conducted from February 2016 to May 2018. All participants were evaluated using Reflux Disease Questionnaire score, Gastroesophageal Reflux Disease Questionnaire score, Taiwanese Depression Questionnaire and Pittsburgh Sleep Quality Index. The chi-square test was used to compare categorical variables and independent t-test was used to compare continuous variables. A paired t-test was used to compare the changes after PPI medication. Pearson correlation and hierarchical linear regression was used to estimate factor associated with change of depression and sleep quality in GERD patients during PPI therapy, separately.
Result: Reflux symptom was getting improved after PPI medication as depression was improved (p<0.001), while sleep quality was getting worse after PPI(p<0.001). The improvements of depression score was slightly associated with the change of reflux (β=0.08; 95% CI=-0.02to 0.20) and NERD patients (β =2.62; 95% CI=0.33to4.92). The improvement of sleep quality was slightly associated with GERD history from two to five years (β=0.90; 95% CI=0.08 to 1.89) while alcohol was negatively associated with the change of sleep quality score (β=-0.74; 95% CI=-1.47to-0.01). Baseline of reflux score was associated with baseline of depression (r=0.40) and sleep quality score(r=0.18).
Conclusion: Depression was getting improved while sleep quality was getting worse after taking PPI medication in GERD patients. The improvements of depression score was associated with NERD and slightly associated with the change of reflux. The change of sleep quality was slightly associated with GERD history from two to five years and alcohol was negatively associated. Baseline of reflux score was associated with baseline of depression and sleep quality score.

Table of Contents
Acknowledgement.....................................................................................................................ii
ABSTRACT.............................................................................................................................iii
Table of Contents......................................................................................................................iv
List of Tables...........................................................................................................................vi
Table of Figure........................................................................................................................vii
CHAPTER I...............................................................................................................................1
1.1 Background..........................................................................................................................1
1.2 Aim and objectives...............................................................................................................2
1.2.1 Aim.................................................................................................................................2
1.2.2 Objectives.......................................................................................................................2
CHAPTER II..............................................................................................................................3
2.1 Definition and types of GERD.............................................................................................3
2.2 Risk factors of GERD..........................................................................................................4
2.3 Depression and GERD ........................................................................................................5
2.4 Sleep Quality and GERD...................................................................................................10
CHAPTER III...........................................................................................................................16
3.1 Study Design......................................................................................................................16
3.2 Data Collection...................................................................................................................17
3.2.1 Sociodemographic factors................................................................................................17
3.2.2 Lifestyle factors...............................................................................................................18
3.2.3 Health information...........................................................................................................18
3.2.4 Questionnaires for GERD symptoms..............................................................................18
3.2.5 Questionnaire for Depression .........................................................................................19
3.2.6 Questionnaire for Sleep quality.......................................................................................20
3.3 Statistical analysis..............................................................................................................21
CHAPTER IV..........................................................................................................................23
4.1 Characteristics of Responders and Non-responders............................................................23
4.2 Characteristics of Responders........................................................................................25
4.2.1 Characteristics of Patients With and Without Depression..............................................25
4.2.2 Characteristics of patients with and without sleep disturbance...............................28
4.3 Associated Factors of the Change of Depression Score Among GERD Patients....31
4.3.1 The Change and Correlation of TDQ Score and RDQ Score Before and After PPI Medication.................................................................................................................31
4.3.2 Associated Factors of the Change of Depression Score Before and After PPI Medication.................................................................................................................... 33
4.4 Associated Factors of the Change of Sleep Quality Score Among GERD Patients........................................................................................................................... 35
4.4.1 The Change and Correlation Between PSQI Score and RDQ Score Before Medication and After Medication ............................................................................35
4.4.2 Associated Factors of the Change of Sleep Quality Score Before and After PPI Medication ......................................................................................................................36
CHAPTER V............................................................................................................................38
5.1 Discussion..........................................................................................................................38
5.1.1 The change of depression during PPI medication .....................................................38
5.1.2 The change of sleep quality during PPI medication .................................................39
5.1.3 Strength and Limitations ............................................................................................40
5.2 Conclusion..........................................................................................................................41
REFERENCES.........................................................................................................................42
APPENDIX .............................................................................................................................47

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