Anxiety and GERD: A Complicated Correlation

Anxiety and Gastroesophageal Reflux Disease (also known as GERD) are two separate conditions. Nevertheless, there is numerous research done on both of these conditions and have concluded that though they may share similar symptoms, anxiety may play a role in the development and worsening of GERD.


Before we go into how both of these conditions are related, let us understand each on their own.


What is Anxiety?


Anxiety as we all know is a feeling of unease, such as worry or fear, that can be mild or severe. This condition can be caused by a major event or any stressful situation that arises.

What is GERD?


GERD on the other hand, is a digestive disorder that occurs when acidic stomach juices or food flow back up from the stomach into the oesophagus. In layman terms, it is known as an acid reflux, but a more serious one.


Acid reflux is a common condition that features a burning pain, known as heartburn, in the lower chest area. It happens when stomach acid flows back up into the food pipe/oesophagus (connecting mouth to the stomach).


Acid reflux is commonly experienced by many people from time to time, but it is uncommon to experience acid reflux frequently – and when you do, it is referred to as GERD. GERD is a mild acid reflux that occurs at least twice a week and it can range from moderate to severe acid reflux that occurs at least once a week.


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

Symptoms of anxiety


Anxiety symptoms vary from person to person. Possible symptoms include:
● difficulty in focusing
● feeling very tense, both physically and mentally
● nervousness or restlessness
● rapid heart rate, breathing or hyperventilating
● other digestive issues, such as gas, diarrhoea and constipation

If you want to know more about anxiety, you can check out our previous article on “Anxiety Causes Symptoms and Management”.

Symptoms of GERD

Besides the most common symptom being heartburn and chest pain, other symptoms of
GERD include:
● bad breath
● nausea or stomach upset
● pain in the chest or abdomen
● painful/ difficulty in swallowing (dysphagia)
● regurgitation of sour liquid or food
● vomiting

Overlapping Symptoms of Anxiety and GERD


Both anxiety and GERD can cause some different symptoms altogether, however there are a few symptoms that both conditions have in common.
Some common symptoms that overlap include:

● Disrupted sleep – acid reflux becomes worse lying down, anxiety makes it
harder to fall asleep
● Globus sensation – a painless feeling of a lump in your throat, a tightening or
choking sensation and the persistent need to clear their throat

● Gastrointestinal issues (heartburn, nausea, and stomach pain)



Bidirectional Causation Between Anxiety and GERD


Certain lifestyle factors may worsen acid reflux, including poor eating habits. Nevertheless, stress – the factor which is closely linked to anxiety, is also known
to worsen acid reflux.


But, how are anxiety and GERD related? Well, there might be a link but the nature is unclear. Nevertheless, there are some overlapping symptoms that might make things confusing for patients.


A 2015 research suggests that anxiety and depression increase the risk of GERD, while others have discovered that GERD has a negative effect on quality of life, which leads to the increase of anxiety and depression.


Another 2018 study shows evidence that the people who had anxiety were more likely to experience GERD symptoms/ increase symptoms associated with GERD.


It is believed that anxiety may make you more sensitive to pain and other symptoms of GERD. The researchers suggested several possible physical reasons for this:


● High anxiety levels may increase stomach acid production.
● Anxiety may reduce pressure in the lower oesophageal sphincter (LES), which is the band of muscle that keeps the stomach closed and prevents acid from
leaking into the oesophagus.
● 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.

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.

Potential Solutions for Acid Reflux/ GERD and Anxiety


Though the presence of both conditions together can make things more complicated for patients, there are some home-based or lifestyle methods that can relieve the symptoms:

Calming Solutions for GERD:

● Avoiding fatty & spicy meals
● Eliminating foods from diet that trigger symptoms
● Consuming over-the-counter antacids, such as calcium carbonate (Tums) or bismuth subsalicylate (Pepto-Bismol)
● Having the last meal no later than 2 – 3 hours before bed


As for solutions to reduce or overcome anxiety, one can:

● Reduce intake of caffeine, alcohol
● Engaging in stress-relief activities like exercising, yoga, meditation
● If needed, take prescription medications by a certified doctor


Some known medication that are advised by doctors for the treatment of GERD and Anxiety as a combination should it be needed include:

● over-the-counter (OTC) antacids
● H-2-receptor blockers (H2 blockers), such as famotidine (Pepcid) and cimetidine (Tagamet)
● proton pump inhibitors (PPIs), such as esomeprazole (Nexium) and rabeprazole (Aciphex)


If the above home solutions don’t work, it is advisable to consult a doctor accordingly. It is always good to relieve stress-related symptoms in order to reduce the risk of getting anxiety or triggering GERD.


WhatsDoc provides some online medical solutions that might be able to assist in your journey of overcoming your stress or if you have symptoms of GERD. Consult a psychotherapist for your anxiety, or a gastro-related specialist to assist in acid reflux issues.

References:
https://www.healthline.com/health/gerd-and-
anxiety#:~:text=A%202015%20study%20found%20that,anxiety%20to%20increased%20stomac
h%20acid.
https://www.medicalnewstoday.com/articles/acid-reflux-and-anxiety
https://www.medicalnewstoday.com/articles/146619
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5137555/
https://www.verywellmind.com/gerd-and-panic-disorder-2584204
https://www.aafp.org/afp/1999/0901/p885.html
https://www.medicalnewstoday.com/articles/acid-reflux-and-anxiety
https://www.everydayhealth.com/gerd/symptoms/connection-between-anxiety-acid-reflux/
https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm18069
https://www.verywellhealth.com/gerd-and-anxiety-5179657
https://carrolldigestivediseasecenter.com/news/how-to-reduce-acid-reflux-and-stress
https://www.cghjournal.org/article/S1542-3565(14)01742-X/pdf

https://www.aaaai.org/Conditions-Treatments/related-conditions/gastroesophageal-reflux-
disease#:~:text=Gastroesophageal%20reflux%20disease%20(GERD)%20is,higher%20risk%20
of%20developing%20GERD.
https://www.nhs.uk/mental-health/conditions/generalised-anxiety-
disorder/overview/#:~:text=Anxiety%20is%20a%20feeling%20of,medical%20test%20or%20job
%20interview.
https://www.mayoclinic.org/diseases-conditions/gerd/symptoms-causes/syc-20361940