Disorders that are caused by anxiety are the most common mental health concern nationally. In fact, over 40 million adults that reside in the United States have an anxiety disorder1. Heartburn—a symptom of acid reflux—is the burning pain of acid indigestion and affects around 15 million Americans every day2.
Could there be a correlation between anxiety and acid reflux? Let’s dive further into the topic.
Symptoms of GERD
GERD, or gastroesophageal reflux disease, is a chronic disease that occurs when acid from your stomach flows into the food pipe and starts irritating the stomach lining3. While it’s usually self-diagnosable, GERD can stem from many related conditions such as obesity, laryngitis, asthma, stomach ulcers, and gallstones.
According to the definition, GERD is a condition of troublesome symptoms and complications that result from the reflux of stomach contents into the esophagus9. GERD usually occurs from physical malfunction rather than emotional impacts, but we cannot rule out anxiety and depression as a cause of acid reflux, heartburn, or GERD.
Symptoms include burning pain around the chest area that usually occurs after eating and worsens when lying down. Acid reflux and heartburn more than twice a week may indicate GERD, as GERD is the cause of severe acid reflux. The overall symptoms can be related to:
- Having trouble swallowing food and fluids
- Having a sore throat
- An increased amount of saliva production
- Unexpected chest pains
There are also specific types of food, such as anything spicy, acidic, or fatty/fried, that can trigger acid reflux symptoms. Certain lifestyle choices, such as alcohol consumption, caffeine consumption, smoking, eating a large meal before sleeping, obesity, or pregnancy, may also intensify GERD symptoms.
Symptoms of Anxiety
Anxiety is a feeling of fear, dread, and uneasiness. It’s a normal reaction to stressful or difficult times usually triggered by a specific stressor—a response to toxic situations with a start and ending point.
Anxiety disorders differ from general anxiety—a subcategory of stress. Anxiety disorders often come out of nowhere, and they’re ongoing, lasting for weeks or months at a time.
While anxiety has many causes and effects, some are more common than others. Different anxiety types include:
- Post-traumatic stress disorder (PTSD)
- Selective mutism
- Social anxiety disorder
- Separation anxiety disorder
- Obsessive-compulsive disorder (OCD)
Because of the many different anxiety disorders, symptoms may be difficult to spot and lead to various anxiety disorders. General signs and symptoms for anxiety disorders include:
- Feeling restless
- Difficulty concentrating
- Muscle tension
- Having a rough time controlling feelings of worry
- Sleeping issues (insomnia)4
Temporary or chronic anxiety can result in a buildup of stress, trauma, personality disorder, genetic anxiety disorders, drug or alcohol abuse, or other mental health issues, such as depression.
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 interchangeably—they actually have different meanings. To clear up any confusion before exploring the connection between GERD and anxiety, let’s 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 (LES; located between the esophagus and stomach) becomes weak or doesn’t 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 isn’t cured in the long term, it may cause cancer.
GERD and Anxiety
Acid reflux and anxiety may share a close connection.
While GERD directly impacts a patient’s general health, daily functioning, and physical/emotional activities, it also influences the health-related qualities of life, such as disruptions during sleep, work, and social activities5.
While anxiety is more of a mental phenomenon, and while acid reflux is a physical phenomenon, researchers suggested that there may be several possible reasons for the connection. Generally, anxiety reduces pressure in the lower esophageal sphincter (the band of muscle that keeps the stomach closed and prevents acid from leaking into the esophagus).
Stress and anxiety may cause long-lasting muscle tension. If this muscle tension affects the muscles around the stomach, it could cause pressure in this organ and push the acid up. High levels of anxiety may increase stomach acid production.
GERD may be a valid reason as to why anxiety exists in some patients. Acid reflux, heartburn, or GERD could disable some forms of human qualities within many, influencing daily activities, which could cause anxiety as a result. But can anxiety cause acid reflux or GERD to exist within patients?
In a cross-sectional study conducted, 258 patients with a diagnosis of GERD were chosen. Out of the 258 patients with GERD, 112 patients had concerns about chest pain. From the research, 107 participants had depression, 89 had some form of an anxiety disorder, and 70 patients had symptoms and diagnoses of depression and anxiety6.
In patients and participants with GERD and chest pain, depression and anxiety were significantly higher.
The conclusion drawn from this study is that anxiety and depression were significantly higher in patients with GERD, specifically those who also reported problems and issues of chest pain.
Because of the study’s limitations, there wasn’t an established causal relationship between psychological factors and reflux symptoms due to the study being cross-sectional.
While acid reflux symptoms seem like they can only be triggered by food and lifestyle choices, they can also be intensified due to stress. Stress is directly linked with anxiety disorders, where anxiety results from trauma, stress buildup, stress due to an illness, or other factors.
However, this isn’t to say that you will always have acid reflux symptoms, heartburn, or GERD if you have anxiety. It also isn’t to say that if you have GERD or acid reflux, it’s due to anxiety.
Additionally, patients with anxiety and depression may be slightly more sensitive to reflux symptoms, experiencing them more severely than those without anxiety disorders7.
Treating GERD and Anxiety
While there may not be a significant relationship between GERD and anxiety, individuals with anxiety may also suffer from acid reflux or GERD. Here are some common treatments for GERD and anxiety.
Successful treatments of GERD symptoms have been related to significant improvement in the quality of living, decreased physical pain, increased vitality, increased physical/social functionality, and better overall emotional wellbeing.
For treating GERD medically, the cost of treating GERD has been deemed more costly than those without GERD. This cost difference is most likely due to higher morbidity in GERD patients, but GERD medication isn’t as expensive8.
Usually, anxiety disorders can be treated mainly on an outpatient basis. Depending on the type of anxiety that a patient has, a treatment plan is formed and followed. The program may include psychotherapy, pharmacotherapy, and other methods to treat successfully.
While anxiety doesn’t have a specific medication that one can take to “get rid of” stress, there are particular medications that an individual can take to decrease anxiety symptoms. These medications usually come with mood-altering side effects, but as modern medicines are improving over time, there may be a day where the side effects aren’t as severe as they used to be.
Because there aren’t enough studies done, there isn’t a significant relationship between GERD and anxiety to successfully claim a direct link. That doesn’t mean there isn’t a connection; it just means there haven’t been enough studies to prove it.
While connections between GERD and anxiety disorders have been forged over several years, anxiety doesn’t directly result in acid reflux or GERD, as causes of acid reflux usually generate from the malfunctioning of the lower esophageal sector of the stomach that allows for stomach digestion and undigested food particles to enter the esophagus.
Since symptoms that are associated with GERD and acid reflux can be triggered due to stress, and since anxiety results from stress (or sometimes, vice versa), we may be able to eliminate anxiety as a direct link to GERD, but we cannot eliminate anxiety disorders as a secondary or background impact to acid reflux.
If you have abnormal acid reflux symptoms, keep an eye out for anything in your life that may cause anxiety. While decreasing fatty food consumption or other methods to get rid of acid reflux, consider taking additional steps to avoid anxiety symptoms, as it could impact acid reflux.