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Can Anxiety Cause Acid Reflux

Can Stress Cause Heartburn

Can anxiety cause acid reflux symptoms?

Has 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.

Acid Reflux Due To Stress

We know that the acidity is not the main factor for reflux.

However, it has been reported that personality traits may be quite important in determining the production of acid in the stomach, and this may predispose to reflux.

To be more clear, people who generally have a higher level of impulsivity and show emotions more freely are more likely to react with a significant increase in gastric acid secretion when stimulated by stress.

As a consequence, stress could actually induce objective reflux of gastric contents, and this can lead to esophagus inflammation, even without the typical symptoms of reflux.

Theres another equally interesting reason why stress could possibly cause acid reflux.

While not much discussed, stress can induce reflux esophagitis because it increases the esophageal mucosal permeability.

This has been demonstrated in experimental rats: when exposed to acute stress, dilated intercellular spaces in the mucosa can be observed.

The direct consequence is a much higher mucosal sensitivity to acidic aggressions, with a more significant inflammatory process.

Finally, stress has a direct action on health-related behaviors such as smoking, diet, alcohol consumption, or physical activity, which in turn may influence the risk of developing actual acid reflux.

Given that, its legitimate to ask the following question.

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.

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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.

Stop Heartburn For Good

Heartburn Causes By Stress Cant Sleep  TransnationalT ...

Some people are able to successfully treat GERD with lifestyle and diet changes or medications. For many people, however, these changes dont stop reflux, they just lessen the symptoms. Acid reflux surgery can stop GERD for good by correcting the problem at its causethe weakened lower esophageal sphincter. Dr. Preeti Malladi is a skilled surgeon who can help you live every day without the pain of acid reflux. Get in touch to schedule an appointment today.

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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 .

Some Antidepressants Reduce Acid Reflux

Contrastingly antidepressants are also prescribed for treating acid reflux and GERD when patients do not respond to proton pump inhibitors.

A low dose of antidepressants such as trazodone, nortriptyline, imipramine, citalopram, fluoxetine is found to reduce oesophagal sensitivity to acid reflux.

A systematic review study published in Clinical Gastroenterology and Hepatology, 2015 reported that antidepressants can modulate oesophagal sensation and reduce chest pain in GERD.

However, there is limited evidence whether antidepressants benefit a subset of GERD patients.

Quick Gist: Clinicians prescribe low dose antidepressants to GERD patients who do not respond to acid-suppressing medications. They are said to benefit in case of oesophagal sensitivity.

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Stress Regulates The Gut Function

We all know the butterflies in the stomach feeling when we are anxious or excited or that pit in the stomach feeling in depression and anxiety.

Neurotransmitter changes caused by mood disturbances as well as stress induce such feelings.

The enteric nervous system interacts with multiple neurotransmitters and agents that can modulate the function of the brain and nervous system.

It particularly interacts with stress-related hormone corticotrophin-releasing factor .

CRF receptors are present in the enteric nervous system. These receptors are responsible for how stress modulates the activity of our gut.

Activation of these receptors can cause stress-induced intestinal contractions, defecation, abdominal pain and may inhibit gastric emptying.

Prolonged stress may even cause intestinal inflammation.

Factors such as delayed gastric emptying and intestinal inflammation have been associated with an increase in acid reflux like symptoms.

Previously, we discussed how low pressure at the lower oesophagal sphincter causes acid reflux.

Short-term stress is found to alter oesophagal contractions and lower the pressure at the oesophagus-stomach junction.

Quick Gist: Stress modulates gut functions such as gut motility, intestinal contractions, abdominal pain etc. Chronic stress may alter gut function in such a way that it triggers acid reflux like symptoms.

Acid Reflux And Depression: The Bidirectional Association


After going over multiple scientific pieces of evidence, we can say that it is hard to ignore the link between acid reflux, GERD and depression.

Both the conditions may co-occur. Stress may cause acid reflux symptoms and persistent acid reflux symptoms may cause depression and anxiety.

Also, acid reflux symptoms may precede the development of mental health disorders.

A study published in Scientific Reports, 2018 highlights the possibility of a bidirectional association between gastroesophageal reflux disease and depression.

The researchers designed two different nested case-control studies. In study 1, patients with depression were compared with individuals without depression and their history of GERD was studied.

In study 2, patients with GERD were compared with individuals without GERD and their history of depression was analysed.

The odds ratio for developing GERD was higher in individuals with depression. Similarly, the odds ratio for developing depression was higher in patients with GERD.

The study had several limitations such as different characteristics of study populations in study 1 and 2, lack of exclusion of factors that might affect both depression and anxiety.

But, this is the first study to confirm the bidirectional association between GERD and depression.

Researchers stated that clinicians treating either of the health condition must consider the presence of the other for better treatment response.

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Anxiety & Depression Worsen Quality Of Life Of Gerd Patients

GERD patients with depression and/or anxiety tend to experience greater symptoms and lower quality of life despite having similar reflux parameters as other GERD patients who do not have mental health issues.

Anxiety in these patients is associated with increased heartburn and chest pain

Patients with Non-erosive reflux disorder tend to experience mental health symptoms more than other subtypes of GERD.

How To Reduce Anxiety And Avoid Acid Reflux

Seeing as there is some pretty strong evidence that anxiety may cause or worsen acid reflux, its probably a good idea for you to know how to reduce stress and avoid acid reflux.

A great way to reduce anxiety is to exercise. Exercise creates and releases various chemicals in the brain, such as serotonin and dopamine, both of which are proven to lessen anxiety, stress, and depression.

People with anxiety often have poor sleeping habits or just do not sleep well, and therefore, a good way to lessen anxiety is by trying to sleep more.

While everything up until this point is true, the fact of the matter is that people are like snowflakes, in that no two are alike. What might work for others to reduce anxiety may not work for you. Therefore, you need to find your own way to deal with it. This could include going for walks in a quiet forest, drinking a hot tea, taking a bubble bath, punching a bag at the gym, or anything else. This is kind of a trial and error type of thing, so dont give up.

One big thing you can do here is to simply learn to say no. Stress is often caused by peoples needs to make others happy, and therefore do things they would otherwise not do. In other words, say no, put yourself first, and ensure that your own mental health is taken care of before you start worrying about others.

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Lpr & Anxiety Correlated

When I think back to when I myself first started having the symptoms of LPR I was highly stressed and generally speaking I was quite a nervous person who had anxiety. Of course, if you have a host of LPR symptoms anxiety could be the cause of it and the LPR and general bad health could make your anxiety worse just by simply worrying about your health like happened to me initially.

When I first had problems with my throat I wasnt aware I had LPR though further down the road I figured out that was what was affecting me. Once I got to that stage I did all of the best proven LPR treatment and it definitely helped me.

Though I feel my mindset change and addressing my anxiety, stress etc. was an extremely important element for me to go that extra step. Not only for me personally as someone who had nervous tendencies and anxiety, but for a lot of others who suffer from LPR also have these tendencies.

I have read a lot of posts from people suffering from LPR everyday and its clear to me there seems to be a relation between stress, anxiety and depression with LPR. Of course, this could be how the person was before they developed LPR or this could be because of the havoc that LPR can cause to someone which can amplify these problems.

Dont just take my word for it, there was a study done to see if there is any relationship between LPR and depression. The result of this study showed a significant association between the depression and LPR. You can check this study here.

How To Prevent Acid Reflux And Anxiety

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Without remedying both acid reflux and anxiety, either can provoke the occurrence of each other through a cyclical effect. The many acid reflux symptoms can lead to anxiety which can in-turn fuel acid reflux symptoms. Or anxiety can raise the pain of heartburn leading to more anxiousness and so on.

Acid Reflux Prevention: Lifestyle and dietary changes are the main ways to prevent acid reflux. Avoid heartburn triggers , slow down while eating, do not overeat, avoid eating before bed, and sleep on an incline.

Anxiety Management: Normal events that trigger anxiety cant be prevented, but they can be managed through:

  • Exercise
  • Laughter
  • Sleep

If you suffer from chronic anxiety disorders such as generalized anxiety disorder, specific phobias, panic disorder, and social anxiety, the help of a medical professional will be required to overcome these disorders.

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Too Much Gastric Acid

Even if stress increases stomach acid levels for some people, they should have no symptoms as long as the acid stays in the stomach.

Stress is often associated with wrong eating habits. Alcohol, chocolate, or simply eating too much can all trigger acid reflux. If gastric acid levels are high due to stress, reflux symptoms are likely to be more severe.

Acid Reflux And Stress Symptoms

Heartburn is the main manifestation of stress-induced acid reflux.

To be more precise, all symptoms are generally exacerbated in the presence of stress and even anxiety.

So, you have to consider what follows:

  • symptoms that generally are typical in acid reflux sufferers are more felt
  • symptoms that generally are typical in people under stress make them more sensitive to the above

Common manifestations of stress are:

  • increased heart rate
  • increased blood pressure and pulse rate
  • increased respiratory rate
  • increased alertness

This is the reason why a person under stress feels much more stimuli than others, including heartburn and other reflux-related symptoms.

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Is It All In Your Head

Does this mean that the symptoms are all in your head? Not likely. Researchers theorize that stress may cause changes in the brain that turn up pain receptors, making you physically more sensitive to slight increases in acid levels. Stress can also deplete the production of substances called prostaglandins, which normally protect the stomach from the effects of acid. This could increase your perception of discomfort.

Stress, coupled with exhaustion, may present even more body changes that lead to increased acid reflux. Regardless of what exactly happens in the brain and the body, those who experience symptoms of acid reflux know that stress can make them feel uncomfortable, and treating lifestyle factors is important.

Adopting coping techniques for managing stress in your life can help reduce your risk of conditions such as heart disease, stroke, obesity, irritable bowel syndrome , and depression. The better you deal with stress, the better youll feel.

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