The Link Between GERD and Anxiety Disorder

Feeling Stressed? Why You May Feel It in Your Gut

The Link Between GERD and Anxiety Disorder

From butterflies in your stomach before giving a big speech at work to an ulcer that acts up whenever things get tough, our gastrointestinal health seems to be intimately connected to our emotions. Gastroesophageal reflux disease (GERD) or acid reflux is no exception, and heartburn symptoms can escalate right along with your workload.

However, the relationship between stress and heartburn is a tricky one; just as one man's stress is another's adrenalin rush, stress may sock in the gut some—but not all—people who have GERD.

And although stress may exacerbate GERD symptoms, it's unly to be the underlying cause of your chronic heartburn.

In the past, stress was thought to be the culprit in a variety of gastrointestinal problems, including ulcers and inflammatory bowel diseases such as Crohn's disease.

Now it's known that bacterial infections (in the case of ulcers) and underlying inflammation (in bowel diseases) are to blame, not stress.

Stomach acid may rise, but not everyone feels the burnEven if excess weight, smoking, alcohol, or other GERD-triggering factors are the underlying cause of your heartburn, stress can make you feel the symptoms of acid reflux more acutely.

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“Stress can affect many gut functions, and we know that patients who are under a lot of psychological stress suffer from more severe reflux symptoms—without necessarily having more severe reflux,” says Mitchell Cappell, MD, PhD, the chief of gastroenterology at Beaumont Hospital in Royal Oak, Mich. “We live in stressful times and heartburn is incredibly common,” he says.

In surveys, the majority of people who experience acid reflux identify stress as a common trigger.

The problem is that studies have failed to find a connection between the stress and the amount of stomach acid in the esophagus, which is the ultimate cause of heartburn pain.

One explanation for this discrepancy is that stress may cause what's known as “hypervigilance.” In other words, stressed people become more sensitive to and have a greater awareness of physical symptoms that may not bother them if they weren't stressed.

In a 2005 study in the Journal of Psychosomatic Research, researchers measured the esophageal acid levels in more than 40 patients who had chronic heartburn and acid reflux.

While the measurement was taking place, the researchers induced stress in half of the participants by requiring them to prepare and deliver a five-minute speech.

The acid levels in both groups were nearly identical; patients in the “stressed” group, however, reported more intense acid reflux symptoms, suggesting that their sensitivity to their symptoms had been heightened.

Findings such as this don't necessarily mean that stress-related reflux is “all in your head.” Some experts suggest that stress may excite areas of the brain that in turn make pain receptors in the esophagus more active. So acid levels may not rise that much more in stressed people than carefree ones, but each drop of acid may become that much more painful.

In addition, it's known that people who are stressed can have a drop in levels of hormone- substances known as prostaglandins, which can help coat the lining of the stomach and protect it from acid, says Jonathan Schreiber, MD, a gastroenterologist at Mercy Medical Center in Baltimore. “Once you are under stress, prostaglandin levels go down.” Certain drugs block the production of prostaglandins, including anti-inflammatory drugs such as ibuprofen and naproxen, which is why this common class of drug is often a cause of stomach problems, including nausea and ulcers.

The bottom line? “There is a strong connection between stress and acid reflux,” says Dr. Schreiber. No matter how the body and mind senses them, GERD symptoms are equally real.

Next Page: Stress reduction is key

[ pagebreak ]Stress reduction is key
Reducing stress can ease heartburn and other gastrointestinal problems, but this is easier said than done, Dr. Schreiber says. “I often tell patients if I could write a prescription to relieve stress, I would write myself one first.”

There are, however, things that people can do to alleviate stress that may help lessen heartburn. For example, exercise is a great stress reducer. “This doesn't mean running a marathon,” Dr. Schreiber says.

“It could be walking for a half an hour a day. You really need to devote enough time to caring for yourself, whether reading a book, going for a walk, or doing yoga.

” Creative pursuits such as writing, artwork, or music also play a role in stress reduction.

“It's really different strokes for different folks,” Dr. Cappell says. “Do whatever it is that calms you. Sometimes it is as simple as listening to music.”

Talking to a therapist, clergy member, or even a good friend about your problems can also help mitigate stress, he says.

Healthy habits go a long way toward combating stress. It's easy to resort to things that we know are not good for us, such as smoking and consuming alcohol or excessive caffeine, when times are tough.

And it's no coincidence that these are some of the same things that doctors know increase our risk of heartburn. Caffeine, smoking, and alcohol may relax the lower esophageal sphincter, which is the muscle connecting the esophagus with the stomach, and allow acid easy access up the food pipe.

If you're under stress, be extra careful to avoid known heartburn triggers such as chocolate, citrus fruits and juices, tomatoes and tomato sauces, spicy or fatty foods, full-fat dairy products, and peppermint.

Other tips include trying to make mealtime as relaxing as possible, perhaps by playing some soothing music. Eating smaller meals also helps. Don't lie down too soon after eating, and try to sleep with your head raised.

The good news is that there are also many types of medications to help combat heartburn if none of these methods helps you feel better.

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9 Serious Conditions That Can Feel Heartburn

The Link Between GERD and Anxiety Disorder

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What to know about that burning feeling in your chest—and when to see a doctor.

Heartburn—or gastroesophageal reflux or acid reflux—is a painful burning feeling in your chest or your throat, according to the US National Library of Medicine (USNLM).

Basically, heartburn happens when your esophagus (the tube that carries food from your mouth to your stomach) relaxes too much and stomach acid comes back up into your esophagus, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). It can be managed by making changes to your diet, cutting back on coffee and alcohol, or through medications.

Having heartburn every once in a while, after a spicy meal or taking a nap too soon after eating, is normal; but if it occurs more than twice a week for more than a few weeks, it's time to see a doctor–in that case, you could have gastroesophageal reflux disease (GERD), a chronic, sometimes damaging form of heartburn.

But GERD isn't the only issue that is related to heartburn. Many other conditions—some even life-threatening—can mimic the feeling of heartburn. Here, nine other conditions that heartburn could be masquerading as—and when to see your doctor about it.




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  • Angina, which is chest pain or discomfort caused by a lack of blood flow to the heart, according to the American Heart Association (AHA), can feel indigestion or heartburn.
  • “The major key is if you're getting heartburn when you're doing strenuous or moderate activity,” says Ryan Madanick, MD, a gastroenterologist and assistant professor of medicine at the University of North Carolina School of Medicine, in Chapel Hill. And if you have additional symptoms, such as sweating or difficulty breathing, it’s ly time to seek medical attention.
  • If you're 50 or older and getting heartburn—especially if you haven't had this kind of pain before—it can also raise suspicion of angina, as can other heart disease risk factors  hypertension, diabetes, or a family history of heart disease.

RELATED: 9 Things That Could Be Giving You Acid Reflux


  • Gallstones are hard, small, pebble- masses that develop in your gallbladder, according to the NIDDK. Although gallstones don't always cause symptoms, a stone blocking your bile duct can hurt, usually in the middle or upper-right side of the abdomen.
  • Pain may be cramping, dull, or sharp, and often strikes minutes after you eat. It’s usually more intense than heartburn and may last longer.
  • If you're experiencing stomach pain after meals that doesn't improve after you take an over-the-counter acid-suppressing medication, gallstones should be suspected, says Joel Richter, MD, a gastroenterologist and chairman of the department of medicine at Temple University School of Medicine, in Philadelphia.

RELATED: What Is Alkaline Water, and Can It Really Help With Heartburn?


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Stomach ulcers, also known as peptic ulcers, are sores on your stomach lining that can cause a gnawing, burning sensation, usually felt in the upper abdomen. The pain can find its way up to the chest, Dr. Madanick says. The pain is often more dull and persistent than heartburn.

Acid-suppressing medications may relieve ulcer pain. But ulcers are often caused by Helicobacter pylori, a type of bacteria that inflames the stomach lining, so you will need to take antibiotics to clear the infection.

Long-term use of certain anti-inflammatory drugs (such as aspirin, ibuprofen, and naproxen), and osteoporosis drugs called bisphosphonates, can also cause stomach ulcers. In this case, your doctor might prescribe medications called proton-pump inhibitors (PPIs) to reduce acid in your stomach, according to the NIDDK.

RELATED: Is It Bad to Pop Antacid Pills Candy?


  • A hiatal hernia occurs when a portion of the upper stomach pokes through the diaphragm into the chest cavity, rather than staying in the abdominal cavity where it belongs.
  • This can push food and stomach acid up into the esophagus, causing heartburn- pain and GERD, according to the NIDDK. Your doctor may be able to diagnose it with an X-ray or other imaging.

Other signs of hiatal hernia include chest pain, belching, and nausea. If you have heartburn due to hiatal hernia, your doctor will typically prescribe acid-suppressing drugs, and recommend lifestyle changes eating smaller meals, avoiding alcohol, and not eating right before bed. In rare cases, surgical repair may be warranted.

RELATED: Heartburn and Other GERD Symptoms


  • Esophageal cancer is rare, but its incidence is rising rapidly in the United States, Dr. Madanick says. While heartburn- pain may be caused by esophageal cancer in rare cases, the most common symptom is difficulty swallowing, according to the American Cancer Society.
  • “If you have heartburn, it might be a sign of esophageal cancer, but it's highly unly,” he says. Your doctor may decide to order an upper endoscopy to examine your esophagus if you've got long-standing heartburn, especially if you smoke or drink heavily, both of which are risk factors for esophageal cancer.
  • This test involves passing a tube with a light and a camera at one end down your throat into your esophagus. During the test, your doctor can look for abnormal areas as well as collect tissue samples to test for cancer.

RELATED: 5 Reasons Why Your Heartburn Medicine Isn't Working



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  • Poor control of diabetes can lead to nerve damage, which can affect the workings of your digestive tract. This is called gastroparesis, and it dramatically slows the movement of food through the stomach to the intestines. This can cause heartburn, as well as other symptoms nausea, vomiting, and feeling full right away after eating, the NIDDK explains.
  • Treatment can include dietary changes such as eating smaller meals, avoiding fat and fiber, medications, and, for people with very severe symptoms, inserting a feeding tube or an implanted device that emits electrical pulses mimicking stomach contractions.

RELATED: How to Fight Heartburn at Home

Klaus Vedfelt/Getty Images

  • Esophagitis, or inflammation of the esophagus, can result from frequent acid reflux. This condition can in turn lead to more heartburn, as well as difficulty swallowing.
  • The esophagus can also become inflamed from taking certain painkillers and osteoporosis medications, particularly if the pills are taken without water, allowing them to remain in the esophagus. In rarer cases, certain infections and radiations can cause the condition, according to the National Center for Biotechnology Information (NCBI).
  • A third type of esophagitis, called eosinophilic esophagitis, occurs when white blood cells known as eosinophils invade the esophagus. The chronic condition is often allergy- and asthma-related, so treatment requires identifying and avoiding the offending foods with the help of a gastroenterologist or allergist. Doctors may also prescribe steroid medications to ease inflammation, according to the American Academy of Allergy, Asthma, and Immunology (AAAAI).

RELATED: 10 Reasons You Have a Sore Throat

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  • Inflammation of the lining of the lungs and chest cavity, known as pleuritis or pleurisy, can cause heartburn- chest pain. Pleuritis should be suspected “if the pain or burning gets worse when you take deep breaths or move around,” Dr. Madanick says.
  • Pleuritis is most commonly caused by a viral or bacterial infection, and resolves when the infection does, according to the National Heart, Lung, and Blood Institute (NHLBI).
  • Costochondritis—an inflammation of the cartilage anchoring ribs to the breastbone—can cause sharp pain along the breastbone or sternum. It can be related to injury or infection, and typically is treated with anti-inflammatory medicines, pain relievers, and rest.

RELATED: 4 Causes of Chest Pain You Might Not Know About


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Although anxiety won't cause GERD, it can cause heartburn and make GERD symptoms worse, Dr. Madanick says. What’s more, panic attacks can sometimes directly cause chest pain, according to the American Heart Association (AHA).

A person can have both anxiety-related heartburn and GERD-related heartburn. “One of the signs that it's not just reflux is that treating the reflux problem doesn't make it any better,” he says.

Reducing anxiety and stress through, for example, exercise, relaxation, and therapy, can also ease heartburn.

Dr. Madanick says that, as with other conditions that masquerade as GERD, “many times the only times we will see a patient…is when the over-the-counter medications haven't worked, because the medications tend to be very effective for treating simple heartburn.”

RELATED: 12 Signs You May Have an Anxiety Disorder


The Link Between GERD and Anxiety Disorder

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Many people believe that heartburn is related to anxiety. While you won't see anxiety listed as a usual risk factor for acid reflux, research published in 2018 shows that a connection exists, although the precise reason why is unknown.

Gastroesophageal reflux disease (GERD), or acid reflux disease, occurs when acid from the stomach refluxes into the esophagus causing symptoms heartburn, trouble swallowing, or a burning taste in your throat. While anyone may have an occasional b heartburn, if you have frequent heartburn it may be diagnosed as GERD.

Getting diagnosed is important because GERD can be treated by lifestyle modifications, over-the-counter medications, and prescription drugs.

If untreated, GERD may lead to complications a chronic cough, erosive esophagitis, and even esophageal cancer.

The structural cause of heartburn symptoms and GERD lies where your esophagus meets your stomach. The esophagus is a muscular tube that connects the mouth to the stomach.

The lower esophageal sphincter (LES) is a ring of muscle that closes the stomach off from the esophagus when you are not eating. When you eat, this muscle relaxes, allowing food to pass smoothly from the esophagus to the stomach.

The LES then closes again so that food in the stomach will not back up into the esophagus.

When the LES does not function properly, GERD may develop when stomach acid refluxes into the esophagus. The stomach acid irritates the lining of the esophagus and leads to the burning sensation known as heartburn.

Typical causes of GERD include increased abdominal pressure (due to obesity or pregnancy), certain medications, smoking, and hiatal hernia. Heartburn may be triggered by overeating, eating too close to bedtime, drinking alcohol, or eating greasy or spicy foods.

While anxiety is not listed as a cause of GERD, research published in 2013 showed the incidence of anxiety in women with GERD is higher than for those in the general population. Also, people with both GERD and anxiety may have more frequent symptoms and more severe symptoms, leading to a reduced quality of life.

Anxiety may play a role in the development of GERD and in worsening of symptoms, although researchers aren't entirely clear how.

Some experts believe that a brain chemical cholecystokinin (CCK), which has been linked to panic and gastrointestinal disorders, may play a role in the prevalence of GERD in people with anxiety disorders. There are theories that anxiety can slow digestion, increase stomach acid, or result in increased muscle tension that can put pressure on the stomach.

Another possibility or contributing factor may be that when people are anxious they tend to engage in behaviors that may trigger or worsen acid reflux, smoking, drinking alcohol, or eating fatty or fried foods. These can be soothing behaviors that can then lead to the pain and discomfort of heartburn.

The reverse may also be true as your GERD symptoms, such as chest pain and trouble swallowing, can be worrisome and increase your anxiety or trigger a panic attack. It's important to remember that a link does not imply causation.

The big picture here is that if you suspect you have anxiety or GERD or both, be sure to see your healthcare professional for a proper diagnosis and treatment plan. The good news is that both can be effectively treated.

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  1. Choi JM, Yang JI, Kang SJ, et al. Association Between Anxiety and Depression and Gastroesophageal Reflux Disease: Results From a Large Cross-sectional Study. J Neurogastroenterol Motil. 2018;24(4):593–602. doi:10.5056/jnm18069

  2. Richter JE, Rubenstein JH. Presentation and Epidemiology of Gastroesophageal Reflux Disease. Gastroenterology. 2018;154(2):267–276. doi:10.1053/j.gastro.2017.07.045

  3. Sanna L, Stuart AL, Berk M, Pasco JA, Girardi P, Williams LJ. Gastro oesophageal reflux disease (GORD)-related symptoms and its association with mood and anxiety disorders and psychological symptomology: a population-based study in women. BMC Psychiatry. 2013;13:194. Published 2013 Jul 24. doi:10.1186/1471-244X-13-194

  4. Chua AS, Keeling PW. Cholecystokinin hyperresponsiveness in functional dyspepsia. World J Gastroenterol. 2006;12(17):2688–2693. doi:10.3748/wjg.v12.i17.2688

  5. Zhang L, Tu L, Chen J, et al. Health-related quality of life in gastroesophageal reflux patients with noncardiac chest pain: Emphasis on the role of psychological distress. World J Gastroenterol. 2017;23(1):127–134. doi:10.3748/wjg.v23.i1.127


How to Deal With Anxiety and Heartburn

The Link Between GERD and Anxiety Disorder

Many of the symptoms of anxiety cause further anxiety. The cyclical nature of anxiety is one of the reasons that this disorder can be hard to treat without some type of outside intervention. You experience anxiety, then you experience very frightening symptoms, and then you experience more anxiety over those symptoms.

This is the case with anxiety and heartburn. Heartburn, also known as acid reflux, can cause numerous symptoms that may lead to significant anxiety, especially if you are prone to health anxiety or panic attacks.

Heartburn and Anxiety

The relationship between anxiety and heartburn is not an obvious one. Not everyone experiences heartburn when they're stressed, and others may be experiencing symptoms of mild hyperventilation which can mimic heartburn symptoms (such as chest pain) and are very common with anxiety.

It's not always as simple as saying “anxiety causes heartburn.” There are several potential causes of heartburn from anxiety:

  • Gastroesophageal Reflux Disease (GERD) Many of those that suffer from heartburn when they have anxiety also have GERD, otherwise known as “acid reflux disease.” Many people live with mild GERD, and one of the factors that causes an increase in GERD symptoms is anxiety. GERD is generally a non-dangerous disease, although the symptoms of GERD may be triggers for panic attacks.
  • Stomach Pressure One of the issues that causes heartburn/acid reflux is pressure around the muscles of the stomach. This is linked to the fact that a common symptom of anxiety is muscle tension. Therefore, it's easy to see how anxiety can potentially push acid up in the stomach and cause the symptoms of heartburn.
  • Excess Stomach Acid It appears that stress increases stomach acid buildup. For many, this can cause issues not only with heartburn, but also appetite. Despite the increase in stomach acid, it's not terribly common for those symptoms to cause heartburn (they often cause indigestion and stomach discomfort, however). Nonetheless, this does happen in some people.
  • Changes in Digestion Stress is known to affect the digestive process both in the intestines and in the stomach. It's possible that anxiety is causing your body to digest food poorly, leading to acid buildup in the stomach that moves up the esophagus. Anxiety may also slow down digestion, leading to similar issues with food moving down the esophagus.

Stress can also affect your hormones and your body's efficiency. Thus, many people with anxiety may have a lower esophageal sphincter (the sphincter that controls acid reflux) that works improperly as a result of anxiety.

Is Anxiety Heartburn Dangerous?

Heartburn, in general, is not dangerous per se. However, there are some risks. For example, both stress and heartburn can lead to ulcers, and ulcers can be dangerous. GERD has a very low chance of causing long term disease. The problem is not just the danger, however. The problem is that the symptoms of heartburn often lead to further anxiety.

This is especially problematic if you have panic attacks. Some of the symptoms of heartburn include:

  • Stomach discomfort.
  • Chest pain.
  • Difficulty swallowing.
  • Chronic cough.

The first three symptoms are known to be triggers for panic attacks. The last symptom can cause hyperventilation if the coughs are too frequent or too hard, and hyperventilation can lead to panic attacks.

Treatment Options for Heartburn From Anxiety

Traditional heartburn treatments only have a moderate effect on anxiety heartburn. Eating smaller meals, taking antacids, and eating foods that do not contribute to heartburn are a good place to start. But they're only going to do half the job, as many people that experience heartburn from anxiety fail to get complete relief when they utilize these treatments alone.

Some of those with anxiety claim to get relief from jogging and other forms of exercise. However, it should be noted that in general, exercise actually makes acid reflux temporarily worse.

In the long term, though, it helps a lot with heartburn.

While these options may prove helpful, there is one thing that should be considered first by people looking to get rid of their heartburn anxiety: address the root of the problem by treating your underlying anxiety! 


The Link Between GERD and Anxiety Disorder

Acid reflux and anxiety may share a close link. Some research suggests that anxiety might make acid reflux symptoms worse.

Anxiety and stress may also be contributing factors to acid reflux in some cases. Conversely, acid reflux can be stressful and may cause anxiety in some people.

People with troubling symptoms or symptoms that do not respond to home treatment should see a doctor.

Acid reflux occurs when acid from the stomach leaks back up into the food pipe, or esophagus. It is a common symptom of gastroesophageal reflux disease (GERD).

Stress can worsen acid reflux symptoms, and anxiety is a natural response to stress in the body. Paradoxically, experiencing anxiety can also in itself be stressful, which can continue the cycle.

There is some evidence to suggest that stress and anxiety may provoke acid reflux or make the symptoms worse.

For instance, a 2018 study involving more than 19,000 people found that those with anxiety were more ly to experience GERD symptoms.

The researchers suggested several possible physical reasons for this:

  • Anxiety may reduce pressure in the lower esophageal sphincter, which is the band of muscle that keeps the stomach closed and prevents acid from leaking into the esophagus.
  • Stress responses and anxiety may cause long lasting muscle tension. If this affects the muscles around the stomach, it could increase pressure in this organ and push the acid up.
  • High anxiety levels may increase stomach acid production.

In some cases, people with anxiety who had the same number of acid reflux episodes as people without anxiety rated these episodes as more severe.

The authors of a study in Clinical Gastroenterology and Hepatology also found that among people with GERD, the symptoms — including pain and heartburn — were more severe in those who had higher levels of anxiety.

Scientists have also noted that GERD can be a major source of stress and anxiety for people.

In 2019, researchers noted that people with GERD who experienced chest pain had significantly higher levels of depression and anxiety that those who did not have pain in this part of the body.

The study authors also suggest that people may associate symptoms such as chest pain with other more serious conditions, increasing their anxiety about these symptoms.

The combination of these factors can allow a vicious cycle to develop. GERD may cause stress and anxiety, yet stress and anxiety levels also contribute to GERD. Finding both physical and psychological ways to treat these symptoms is vital to break the cycle and find relief.

Other factors that can lead to acid reflux include:

  • eating meals just before bed
  • eating large or fatty meals
  • including spicy foods in meals
  • having obesity
  • consuming alcohol
  • smoking

Understanding the symptoms of GERD and anxiety may help a person distinguish between them.

Symptoms of GERD

GERD is a condition that causes regular acid reflux, as stomach acid often leaks back up into the esophagus. It causes a number of symptoms, the most common being heartburn.

Heartburn is a painful, burning feeling in the middle of the chest and, sometimes, in the throat. It occurs when the acid from the stomach irritates the esophagus.

Symptoms of GERD may include:

  • heartburn
  • nausea or stomach upset
  • pain in the chest or abdomen
  • painful swallowing
  • vomiting
  • bad breath

Symptoms of anxiety

Anxiety symptoms vary from person to person. Possible symptoms include:

  • rapid heart rate
  • nervousness or restlessness
  • twitching muscles
  • feeling very tense, both physically and mentally
  • rapid breathing or hyperventilating
  • a feeling of dread or constant impending doom
  • difficulty focusing
  • other digestive issues, such as gas, diarrhea, or constipation
  • inability to sleep

Anxiety may also present as sudden, intense signs of distress called panic attacks. Panic attacks occur when severe symptoms come on very quickly. These can include extreme fear, drastic changes in heartbeat, and changes in breathing.

Learn more about anxiety’s effects on the body in this article.

Many people deal with occasional acid reflux and feel anxious from time to time when they are facing a stressful situation.

When either or both symptoms become regular occurrences, it is important to take steps to treat or prevent them.

Additionally, as the symptoms of acid reflux and anxiety may make each other worse, taking quick action may help prevent this cycle from developing.

People may be able to relieve the symptoms of GERD using one or more methods, including:

  • finding and eliminating foods that trigger symptoms
  • avoiding large or very fatty meals
  • eating their last meal no later than 2–3 hours before bed
  • taking over-the-counter antacids, such as calcium carbonate (Tums) or bismuth subsalicylate (Pepto-Bismol)
  • taking proton pump inhibitors, such as esomeprazole (Nexium)
  • using H2 receptor blockers, such as famotidine (Pepcid)

Doctors may also recommend taking steps to reduce or prevent anxiety, including:

  • attending regular cognitive behavioral therapy (CBT) sessions
  • reducing the intake of caffeine
  • avoiding recreational drug and alcohol use
  • engaging in stress relief techniques, such as yoga, meditation, or tai chi
  • taking prescription medications, such as serotonin-norepinephrine reuptake inhibitors (SNRIs) or benzodiazepines

In some cases, it is possible to manage the symptoms of both acid reflux and anxiety with home remedies.

However, anyone experiencing chronic anxiety or acid reflux should speak to a doctor.

Long-term acid reflux may cause other complications, such as scar tissue in the esophagus, Barrett’s esophagus, and, in rare cases, esophageal cancer.

Long-term anxiety can contribute to a range of physical and mental health complications.

The symptoms of both GERD and anxiety can appear similar to those of other conditions. Therefore, it is advisable to visit a doctor for a diagnosis.

Dealing with the combination of acid reflux and anxiety can be frustrating. In some cases, a person may not know whether they are experiencing acid reflux or the physical symptoms of anxiety.

Working with a doctor is important to ensure that the person gets the correct treatment.

Finding ways to manage anxiety and taking steps toward treating acid reflux may help end the cycle and help people control their symptoms.


What’s the Connection Between Anxiety and Acid Reflux?

The Link Between GERD and Anxiety Disorder

Heartburn, belching, nausea — everybody feels the symptoms of gastroesophageal reflux disease (GERD) from time to time. But do those symptoms come from an actual medical issue? Or are some patients just extraordinarily sensitive to small changes in their digestive tract?

A new study suggests that the answer might depend on the patient’s mental health.

Fernando Herbella, MD, a gastroenterologist at the Federal University of São Paulo in Brazil, and his colleagues examined 222 patients who all suspected they had GERD. Each patient took a 14-item questionnaire to test for anxiety and depression. Some of the patients had these mental health issues and others did not.

Then the researchers observed the pH values in each patient’s esophagus, because an acidic pH value is a common indicator of GERD. They found that nearly half the patients who reported having anxiety and depression had normal pH values in their esophagus — indicating that they most ly did not have GERD.

Are these patients exaggerating the symptoms they feel, or feeling symptoms more acutely? Dr. Herbella believes it’s the latter. “Patients with anxiety and depression or other mental health issues display a ‘hypervigilance’ or ‘hypersensitivity’ to pain sensations,” he says.

In the case of GERD,  an extremely common — and usually mild — digestive health problem that affects about 3 million Americans every year, this hypervigilance has curious effects on patient perception.

The study found an inverse relationship between anxiety levels and esophagus pH; the more anxious the patient was, the less damaged their esophageal lining.

And they found that depression was directly related to esophagus pH — but only in women.

“I really couldn’t even venture a scientific explanation for that,” Herbella says.

The findings, presented at Digestive Disease Week 2018,  illustrate just how much psychiatric disorders complicate GERD treatment and diagnosis.

Psychiatric Disorders and Pain Perception

Vic Velanovich, MD, a gastrointestinal surgeon and one of the study’s co-authors, says this is not an isolated phenomenon. It’s part of a broader problem in assessing the severity of disease. “It’s always very difficult to correlate patient-perceived symptoms with actual physiological measures,” he says.

Dr. Velanovich offers a neurological explanation. “It’s called the ‘pain modulation network.’ Pain is converted to electrical signals that travel to the brain. It’s interpreted there by the frontal cortex. So anything happening in the frontal cortex, including mental disorders, makes pain perception worse.”

Velanovich has been exploring the effects of the pain-modulation network for some time. In 2001, he published a study examining whether psychiatric disorders affected patient satisfaction with GERD-correcting surgery. He found that surgery satisfied 93.5 percent of patients without psychiatric disorders, and just 11.1 percent of patients with them.

“It was a classic ‘nocebo’ effect,” Velanovich says. “For both groups of patients the GERD pain was greatly relieved. But only anxious patients found the aftereffects of the surgery intolerable. Which tells me that there’s something else going on.”

This research illustrates how fraught the diagnosis and treatment of GERD can be for gastroenterologists.

“The biggest point is that clinicians can’t rely on patient-reported symptoms to diagnose GERD,” Herbella says.

  “And they certainly shouldn’t skip right ahead to treatment just because a patient is raising complaints. Always look for objective physiological measures before making a diagnosis.”

He also suggests that some of the onus lies with primary care physicians, who he says should be careful to observe any psychiatric issues that occur alongside GERD symptoms.

Velanovich agrees. “My suspicion is that patients with these psychiatric problems are hunting for a physiological cause for some discomfort that they have.”

But he’s careful to emphasize that this is not the patient’s fault. “It’s not a moral failing! People with mental disorders often have little control over their conditions. But it’s important not to give these patients unnecessary treatment that could potentially do them harm. That’s why patients and physicians need to be careful.”


You might have acid reflux

The Link Between GERD and Anxiety Disorder

One possible explanation for GERD: your sparkling water habit. Carbonated beverages tend to relax the bottom of the esophagus, per Gupta. When the lower esophageal sphincter (LES), a muscle at the entrance of your stomach, is relaxed, acid from your stomach can pass back up into the esophagus. If it happens often, it gets diagnosed as GERD (gastrointestinal reflux disease).

Other popular drinks that have the same effect include coffee (caffeine is a trigger), energy drinks (a double whammy as they’re often carbonated and caffeinated), and alcohol of any sort.

You shouldn’t go cold turkey on any of these delightful things if you’re not experiencing symptoms. But you should partake in moderation.

“People think they’re doing a good thing by drinking sparkling water as a way to stay hydrated, but there is such thing as too much of a good thing,” says Gupta.

The anxiety-stress connection

Here’s where things got even more interesting to me. I came across several articles and studies that linked reflux to anxiety, stress, and depression. As someone who has dealt with anxiety since freshman year of college, I was immediately intrigued—it would make total sense that anxiety was the culprit behind this sudden onset of reflux.

A 2017 study in the World Journal of Gastroenterology concludes: “Psychological factors, including anxiety and depression, play an essential role in the development of GERD and especially that of NERD (nonerosive reflux disease).

” Other studies have suggested that anxious or depressed people or more ly to develop reflux symptoms. This Swedish study from 2007 found that people with anxiety had a 3.2-fold increased risk of reflux symptoms while those with depression had a 1.

7-fold increased risk.

When I asked Dr. Morrison about this, he wasn’t surprised. “In New York City, most people would admit that they are generally running on adrenaline, keeping their energy levels up, stretching the day to its longest amount of time,” he said. “Running on adrenaline and stress means that they're running on fight or flight, or the sympathetic nervous system.

” That’s a problem because your digestive tract does not activate in fight or flight. “It’s evolutionary, you're not supposed to be digesting your food when you're running away from a tiger which is what that system was designed to help you do,” says Morrison.

“If a person is not digesting properly, then the food just sits in the stomach, and then keeps on refluxing back up.”

Furthermore, our bodies normally produce prostaglandin, a fatty acid that protects the stomach lining from acid exposure. “Stress and anxiety cause a reduction in prostaglandin, which makes a person more susceptible to acid reflux symptoms and can even cause ulcers,” says Gupta.

“You’re doing your best digestion when you are in the parasympathetic nervous system, in a relaxed state,” Morrison says. Read: sitting down, cutting up your food, and chewing it up calmly.

But these days, most of us are probably eating while we’re on our phone or computer, which “makes digestion terrible,” per Morrison. The fix sounds simple and is something you’ve probably heard a hundred times—eat mindfully to prevent and alleviate reflux.

“It’s best to eat when disconnected from social media or better yet, while spending time with someone or something that makes you happy,” says Morrison.

For those that have trouble doing this at first, stick to cooked foods (rather than raw veggies) as they’re easier to digest and of course, avoid acidic food which aggravate inflammation in the stomach.

Bigger picture, you need to relax. “I talk to my patients about engaging in ‘me time’, something that helps them deal with day-to-day stress going for a run, watering their plants, yoga or meditation or Thai Chi,” says Gupta.

Chest breathing activates the sympathetic nervous system. Belly breathing, on the other hand, helps the diaphragm to stretch out with each breath, and helps put you in a parasympathetic state. Try a breathing exercise this one or this one before each meal to help you activate the parasympathetic nervous system. 

If your symptoms persist, you should see your doctor to rule out other possibilities including stomach inflammation.

Chronic acid exposure also puts people at risk for certain conditions, which can be precancerous, such as Barrett's esophagus.

“We have continued evidence from recent research to convince our younger folks about the importance of diet and lifestyle and stress management,” Gupta says.