Baseline Characteristics Of The Study Subjects
A total of 6,834 subjects were included in this study. Women accounted for 45 % of subjects, and the mean age of all subjects was 43.9 years. Reflux esophagitis was found in 407 and active to healing-stage PUD was found in 404 subjects .
The study population was classified into two groups according to BEPSI-K scores: the stress group and the reference group. The stress group was defined as those having a BEPSI-K score > 2.4. A total of 902 subjects were included in the stress group, with a mean BEPSI-K score of 2.92 ± 0.61 . Compared with the reference group, women were more common, and the mean age was younger in the stress group. The proportion of coffee drinkers was relatively smaller in the stress group. Subjects who were current smokers and those with low education and low income were more common in the stress group than the reference group. Subjects with reflux esophagitis were more prevalent in the stress group compared with the reference group . The prevalence of PUD in the stress group was higher than that in the reference group however, the difference did not reach statistical significance . Seriously obese people were more common in the high-stress group .
Stress Leads To Worse Symptoms
In terms of how stress causes increased GERD symptoms, its still unknown, but evidence does suggest that it can make people more sensitive to acid reflux. In 1993, for instance, a study showed that while increasing stress among test subjects did affect their subjective assessment of pain from acid reflux, there wasnt any real change in acid exposure or frequency.
Acid Reflux And Anxiety: Learning Body
Anxiety is defined as the natural response to stress, and depending on the duration, it may become a true anxiety disorder.
This happens when anxiety lasts for several months, and, more important, it impairs the normal quality of life.
This is the most important reason to wonder if anxiety could be included in the list of ascertained causes of acid reflux.
Talking about trends, we can say that both of these conditions are always more frequent, thats why is important to investigate any possible relationship between them.
According to some studies, anxiety and depression may play an important role in the occurrence of GERD.
This evidence is even more relevant for people who suffer from NERD, meaning that they do not have esophageal erosion.
The table below is taken directly from the official study and presents the perceived level of anxiety among people who suffer from heartburn and reflux.
A more recent study reported that anxiety and depression levels were significantly higher in subjects with GERD than in healthy people.
This is a further confirmation of what was found before.
However, theres consideration to add.
Anxiety effect on people who suffer from reflux has nothing to do with the acid and/or the burning sensation in the esophagus.
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Can Stress Cause Heartburn
Has anxiety ever given you butterflies in your stomach? Or have you ever felt gut-wrenching stress? If you answer yes, you’ve experienced the close link between your emotions and your stomach. Stress can give you a bout of heartburn. If you already suffer from heartburn, stress can make it worse.
Heartburn occurs when stomach acid seeps up into your esophagus. That’s the tube that gets food from your mouth to your stomach. Once food is in your stomach, your body releases acids to digest it. Your stomach can deal with acid, but the esophagus can’t. So, when acid gets into the esophagus, it burns.
Learn About Mechanisms Behind Stress Or Anxiety Causing Acid Reflux
You may know full-well that acid reflux can be caused or triggered by anxiety and stress. But just how does this work?
Stress may cause increased vagal nerve stimulation in the brain, which may lead to increased acid production in the stomach, says Jonathan Zinberg, MD, chief of gastroenterology at South Nassau Communities Hospital, Oceanside, NY.
This was his first thought regarding this under-researched phenomenon.
Dr. Zinberg then explains, There are many theories regarding stress and heartburn. Some say that increased cortisol/epinephrine leads to less blood flow to the stomach, with slow digestion and emptying of the stomach, with subsequent reflux.
He continues, Some point to decreased prostaglandin in the stomach, which helps to protect the lining of the stomach .
Others blame stress for causing general poor habits for causing worse reflux .
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How To Deal With Anxiety And Heartburn
- Heartburn, and GERD , have several links with anxiety.
- Some people already have GERD that gets worse when they have anxiety.
- Symptoms of GERD can also trigger further anxiety, especially in those with panic attacks.
- There are at least 4 links between anxiety and heartburn.
- Treating heartburn independently can be effective, although anxiety treatment should still be prioritized.
Symptoms May Be More Noticeable
Its not been proven that a person who is stressed out produces more stomach acid or that more is directed to the esophagus to cause unpleasant symptoms such as heartburn and regurgitation. But when theyre under stress, people with acid reflux notice their symptoms more and say they feel more intense.
If youre stressed, you may simply be more sensitive to your physical symptoms. Your acid reflux isnt physiologically worse, but the negative effect it has on your well-being is magnified.
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The Link Between Anxiety And Gerd
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 the brain chemical cholecystokinin , which has been linked to both panic disorders 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, like 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 GERD symptoms, such as chest pain and trouble swallowing, can be worrisome and increase anxiety or trigger a panic attack. It’s important to remember that an association does not imply causation.
Does Stress Really Make It Worse
Its still debatable whether or not stress actually increases the production of stomach acid or physically creates a worsening in acid. Currently, many scientists believe that when youre stressed, you become more sensitive to smaller amounts of acid in the esophagus.
In 1993, researchers published in the American Journal of Gastroenterology that people with acid reflux who were anxious and stressed reported having more painful symptoms related to acid reflux, but no one showed an increase in gastric acid. In other words, though people consistently reported feeling more discomfort, the scientists didnt find any increase in total acid produced.
Another study from 2008 added further support to this idea. When researchers exposed people with GERD to a stressful noise, they also found that it increased their symptoms by making them more sensitive to acid exposure.
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Characteristics Of The Study Subjects
This study included 19 099 subjects, among whom 1574 had reflux symptoms. Subjects with reflux symptoms were classified into the ERD and NERD groups according to the endoscopic findings of the gastroesophageal junction. Among 19 099 subjects, 1368 had endoscopically proven esophageal mucosal erosions/ulcers but did not have any reflux symptoms, and they were classified as the AEE group. The remaining subjects were classified as the control group. The baseline demographic and clinical characteristics of the study subjects are shown in Table 1. Subjects in the ERD and NERD groups were significantly younger than those in the control group . The percentage of women was lower in the ERD and AEE groups than in the control group (14.2% and 11.5% vs 37.3%, P
< 0.001), and the AEE and control groups . In addition, significant differences were also observed among the 3 subtypes . The percentage of subjects who exceeded the cutoff value for each psychological score showed the same pattern as the aforementioned comparison using the mean value .
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Causes Of Heartburn And Acid Reflux
Lots of people get heartburn from time to time. There’s often no obvious reason why.
Sometimes it’s caused or made worse by:
- certain food and drink such as coffee, tomatoes, alcohol, chocolate and fatty or spicy foods
- being overweight
- some medicines, such as anti-inflammatory painkillers
- a hiatus hernia when part of your stomach moves up into your chest
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Which Types Of Doctors Treat Indigestion
You might first see your primary care doctor who will diagnose your indigestion. You may be referred to a gastroenterologist, a specialist in disorders of the gastrointestinal tract.
If you have a problem that requires surgery such as a severe ulcer or gallstones you may be referred to a general surgeon.
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The Role Of Stress In Acid Reflux
You do everything right to suppress your acid reflux. You avoid spicy foods and alcohol. You leave plenty of time between dinner and bedtime. You eat small meals, and you even quit smoking. Good for you youre doing a great job of managing your condition.
Flare-ups can still occur, however, due to circumstances beyond your control. Stressful events, whether a big presentation at work or a big move, can irritate your acid reflux. Research reports that people who feel stressed are more likely to experience more intense acid reflux symptoms or chronic GERD.
Dr. Bharat Pothuri of GastroDox in Cypress, Texas, wants you to know the following about the relationship between stress and acid reflux.
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When Should I Call A Doctor For Indigestion
Indigestion symptoms are signs of other medical conditions or problems.
If indigestion symptoms are mild or resolve in a short time, talk to your doctor about how to treat it.
If you have any of the following symptoms of severe indigestion, if your symptoms last more than a few days, or if they worsen noticeably, seek medical care immediately:
- Vomiting or blood in vomit
- Loss of appetite
- Black, tarry stools or visible blood in stools
- Severe pain in the upper right abdomen
- Sudden, severe pain in the abdomen, particularly on the right side
- Yellow coloring of the skin and eyes
- Discomfort unrelated to eating
- Lightheadedness, dizziness, or fainting due to symptoms
Heart attacks may cause symptoms often are mistaken for indigestion. If indigestion is accompanied by shortness of breath, sweating, chest pain, or pain radiating to the jaw, back, neck or arm, seek medical attention immediately.
Tips For Managing Gerd And Anxiety
For a patient who suffers from both GERD and anxiety, Lupe says that treatment should focus on caring for the whole person.
This includes traditional medical treatments like proton pump inhibitors, antacids, and H2 blockers. These are treatments that will actually go after anything physically that could be going on with acid dysregulation or dysfunction within the stomach, Lupe says.
Certain lifestyle changes can also help alleviate GERD symptoms:
- Avoiding common trigger foods and beverages like fatty or fried foods, citrus, chocolate, mint, garlic, onions, caffeine, and alcohol
- Eating small, frequent meals
- Avoiding lying down after meals
- Not wearing tight-fitting clothing
- Quit smoking
In addition to these steps to treat physical symptoms, finding ways to manage stress and anxiety should also be part of the treatment plan, Lupe says. These may include cognitive behavioral therapy, mindfulness meditation, relaxation techniques, and hypnosis.
These interventions can reduce the load on the central nervous system and help with the reregulation of detection of symptoms, Lupe says. Because if the patient’s detecting things that aren’t necessarily happening due to developed hypersensitivity, the medications aren’t going to be as effective.
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Causes Of Acid Reflux Disease
Seek Medical Help When Needed
Antacids are commonly the most common medical treatment when it comes to acid reflux. These work by neutralizing your stomach acid, making those symptoms less intense. If these dont help, your doctor may recommend foaming agents, H2 blockers, or proton pump inhibitors, that work to reduce acid production or coat the stomach and prevent the acid-causing issues.
If you notice your heartburn is severe, its best to seek help to get the right treatment option for you and not self-medicate.
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Does Stress Really Make Acid Reflux Worse
Often, we may experience acid reflux when we are stressed, so it might seem obvious that there is a connection, but is this really the case? Its true! Acid reflux and stress are connected. Although, the exact reason as to why is up for discussion. In one study, 45.6% of participants noted that stress was a contributing factor in their acid reflux, meanwhile, another, comprising over 19,000 participants, noted that anxiety was a common element in patients with GERD than in the control group.
But why is this? Scientists suspect a number of factors to be at fault. Stress naturally causes muscle tension and over time as anxiety builds this can lead to pressure on the stomach. In addition, anxiety may increase its acid levels causing them to flow backward into the esophagus, which is already under stress. Combined, these give that feeling of burning and discomfort that we know so well.
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Acid Reflux Vs Heartburn Vs Gerd
There is a lot of confusion between the three terms: acid reflux, heartburn, and GERD, as the three terms are often used interchangeablythey actually have different meanings. To clear up any confusion before exploring the connection between GERD and anxiety, lets quickly talk about the difference between the three.
Heartburn is often misleading since heartburn has nothing to do with the heart. Heartburn involves mild to severe pain in the chest area, often confused for heart attack pain. Since the lining of your esophagus is more delicate than the lining of your stomach, the acid in your esophagus causes a burning sensation in your chest.
On the other hand, acid reflux occurs when the lower esophageal sphincter becomes weak or doesnt tighten properly. The LES is in charge of tightening and loosening the esophagus after food passes to the stomach. If this muscle is weak, the acid from your stomach may move back into your esophagus, which as a result, causes acid reflux.
GERD is simply a chronic form of acid reflux. When acid reflux occurs more than twice a week and causes inflammation and pain, GERD is diagnosed. If GERD isnt cured in the long term, it may cause cancer.
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So Can Anxiety Cause Acid Reflux
Yes, there are numerousstudiesconcluding that stress and anxiety can indeed cause acid reflux.
These are the most important factors that trigger heartburn and acid reflux while under stress:
- Poor digestion might lead to gas buildup in the stomach.
- Muscle tension, just like gas, might also increase stomach pressure.
- Relaxed LES, combined with an increased stomach pressure it becomes easier for digestive juices to enter the esophagus.
- Hypervigilance, a condition when one has exaggerated reactions to certain stimuli. In our case, this could mean that even mild heartburn might feel like severe chest pain.
How To Relieve Acid Reflux And Anxiety
Having acid reflux doesnt mean you have anxiety. Likewise, anxiety wont necessarily cause or affect heartburn symptoms. However, if youre noticing symptoms of acid reflux, anxiety, or both, the first thing to do is to talk to your doctor. There are many ways to manage heartburn symptoms. You can also focus on eliminating trigger foods, or try an OTC treatment like Nexium 24 HR for heartburn relief for frequent heartburn that occurs more than two times a week. For occasional heartburn or intermittent heartburn you can turn to products like TUMS or Gaviscon.
If you have concerns about anxiety, the best thing you can do is talk to your doctor. They may be able to offer advice on how to reduce anxiety and manage any associated symptoms. In the meantime, just focus on taking care yourself. Try to alleviate stress by exercising, meditating, eating a healthy diet, and getting enough rest each night. And do things that make you happythat is always the most important part.
Would you like to learn more about acid reflux and heartburn? Learn about common heartburn myths with Nexium 24 HR.
1. Stress vs. Anxiety Knowing the Difference Is Critical to Your Health. Mental Health First Aid. . Accessed 5/13/2020. Referenced text is enclosed in a red box in source PDF.
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