Panic disorder (PD) is a non phobic anxiety disorder that affects 1,5 to 4% worldwide. It is characterized by unmotivated acute attacks, with mental and somatic symptoms, and by an anxiety which precedes the crises, resulting in functional disturbance. The objective of this case study is to describe the association between PD and gastroesophageal reflux (GR). MCL, 25 years, presented with frequent panic crises, with low response to the therapy for 6 months, even after modification of medication doses. Investigation was carried out and diagnoses defined as GR. The treatment resulted with elimination of the panic crises. The acute thoracic pain of the GR is interpreted as a near threat, causing uncertainty regarding an unwell feeling with hyperventilation, acting as a trigger of the panic cognitive cascade, in the dorsal mesencephalon. The esophagic mucosa inflammation is interpreted as a distal threat, stimulating the amygdale and generating anticipated anxiety, increasing stress hormones. According to Deakin-Graeff model, even though 5HT inhibits the panic attack and stimulates the anticipated anxiety, the panic disorder stimulates the latter through dorsal raphe nucleus. In conclusion, the association between PD and GR should be better identified in order that the correct diagnosis and adequate treatment is achieved.
Panic disorder; panic; gastroesophageal reflux