The Connection Between GERD and Anxiety
The two conditions have a complicated relationship
Medically reviewed by Robert Burakoff, MD
Gastroesophageal reflux disease (GERD) is a disorder in which the lower esophageal sphincter closes incorrectly. Reflux of stomach acid into the esophagus can cause heartburn and other symptoms. In the United States, it is estimated that about 20% of adults have GERD.
Anxiety is a mental health condition characterized by worry that is disproportionate to the situation and limits daily functioning. There are multiple types of anxiety disorders. It is estimated that 31.1% of adults in the United States will have an anxiety disorder at some point in their lives.
Even though GERD and anxiety may seem completely unrelated, researchers believe there is a connection between these two conditions. In fact, researchers urge healthcare providers to deliver mental health assessments for any patient who has GERD to enable the best possible treatment outcome.
Verywell / Michela Buttignol
Causes of GERD
When we eat food, it passes through the esophagus into the stomach, which produces acid and pepsin to aid digestion. In a typical individual, the lower esophageal sphincter is a barrier that prevents this acid, pepsin, or food from regurgitating back into the esophagus.
Sometimes, this sphincter does not operate properly, and stomach acid re-enters the esophagus. This in itself is not a diagnosable condition, and many people will experience this occasionally throughout their life. However, when this occurs long term, a person may experience life-impacting symptoms and complications and be diagnosed with GERD.
Researchers have not found an identifiable single cause for GERD. However, physical factors that can cause GERD include:
A weak or injured lower esophageal sphincter
Delayed stomach emptying
Abdominal distention (such as in pregnancy)
Eradication of Helicobacter pylori infection (which can increase stomach acid content)
It is not clear why exactly these occur, and the answer likely varies based on each individual’s circumstances.
Symptoms of GERD include:
Acid reflux
Heartburn
Chest and abdominal pain
Bad breath
Wheezing
Chronic cough or hoarseness
Trouble swallowing
Nausea or vomiting
Insomnia
Complications that can result from untreated GERD include:
Esophageal stricture
Esophageal adenocarcinoma
Asthma
Laryngitis
Tooth enamel wear
GERD and Anxiety
Several studies have found that anxiety is significantly higher among people with GERD than in people without GERD. It is not totally clear why, however this is the case. Researchers have offered two theories about the connection between GERD and anxiety.
Anxiety may trigger the development of GERD or make it more likely a person will develop GERD. Because of the prevalence of people who have both GERD and anxiety, some researchers have hypothesized that anxiety could predispose someone to develop GERD.
Other researchers have proposed that psychological conditions, including anxiety, might have physiological effects that lead to GERD, such as changing esophageal motility and increasing gastric acid secretion through the body’s stress response. This theory has been supported in animal studies with rats, but not in recent human studies.
GERD symptoms may increase anxiety. There also appears to be a relationship between the severity of symptoms of GERD and anxiety. Having severe GERD symptoms can be a stressful experience and may thereby increase anxiety.
One study monitored people with GERD over a 24-hour period and found that a higher level of anxiety was associated with higher severity of retrosternal pain and burning. Another 2019 study found that in people with GERD, anxiety was increased in those who also had chest pain.
A 2016 study also found a positive association between GERD, anxiety, and poor sleep quality, which is a shared symptom of the two conditions.
Unfortunately, due to how these studies were performed, it is not clear if GERD symptoms worsen anxiety or if anxiety worsens GERD symptoms. Clearly, however, there is a relationship between the two.
Symptoms in Common
While GERD and anxiety are two distinct conditions with their own symptom profiles and diagnosis criteria, they have some overlapping symptoms. These include:
Poor sleep quality
Nausea
Vomiting
Chest pain
Abdominal pain
Treating GERD and Anxiety
If someone has GERD and anxiety, it is particularly important for a treatment plan to be devised with both of these conditions in mind. This is because common medications used to treat anxiety have been found to worsen GERD symptoms.
For example, you may want to avoid benzodiazepines, as these medications can lower the body’s pain threshold and increase a person’s sensitivity to and painful perception of reflux symptoms.
It is important to discuss the best medication for you with your healthcare provider, taking into account your personal history and unique situation.
Treatment for Anxiety
Medications that can help those with both anxiety and GERD include:
Tricyclic antidepressants (TCAs)
Serotonin-norepinephrine reuptake inhibitors (SNRIs) are another medication that is commonly used to treat anxiety, which has not been shown to worsen GERD symptoms.
Treatment for GERD
Healthcare providers may recommend a combination of over-the-counter and prescription medication to treat GERD. In rarer cases, surgery might be indicated.
Typical treatments for GERD that are not contraindicated if you also have anxiety include:
Over-the-counter antacids
H2 blockers
Proton pump inhibitors
Other Treatment Options
In addition to medication or surgery, other treatment options and lifestyle changes appropriate for both anxiety and GERD include:
Psychotherapy or counseling
Eating a well-balanced diet
Reducing stress
Progressive relaxation
Yoga
Meditation
Sleep hygiene
The Importance of Sleep Quality
As you adjust your lifestyle to treat anxiety and GERD, it may be helpful to focus on your sleep quality and length. Research has found an association between anxiety, GERD, and poor sleep quality.
We do not know the exact relationship between these, but it has been theorized that improving sleep quality could also improve GERD and anxiety symptoms.
Discuss your sleep patterns with your healthcare provider or therapist. They may recommend a supplement like melatonin or changes like using blackout blinds, removing electronics from your bedroom, and more.
A Word From Verywell
One thing that is known for certain is that there is an association between GERD and anxiety. We do not know, however, the exact relationship of how these two conditions interact.
It may be that having an anxiety disorder predisposes you to develop GERD, either through psychological factors or physiological factors that increase stomach acid. Conversely, it may be that GERD symptoms like insomnia, chest pain, and heartburn create a stress response in the body which triggers anxiety.
While the exact interplay of GERD and anxiety remains unknown, it is still important to remember that your experience is valid. It can be stressful to live with these conditions either alone or in combination, and you deserve a treatment plan that takes both your mental and physical health into account.
If you feel that your GERD, anxiety, or both impact your daily life and functioning, speak to your healthcare provider about your concerns.
Related: Acid Reflux Headache: Symptoms, Causes, and Treatments
Read the original article on Verywell Health.
