GERD and Stress—Why You May Feel It in Your Gut

From butterflies in your stomach before giving a big speech at work to an ulcer that acts up whenever things get tough, our gastrointestinal health seems intimately connected to our emotions. Gastroesophageal reflux disease (GERD), or acid reflux, is no exception, and heartburn symptoms can escalate along with your stress level.

However, the relationship between stress and heartburn is tricky; just as one person's stress is another's adrenalin rush, stress affects those with GERD differently.

And although stress may exacerbate GERD symptoms, it's unlikely to be the underlying cause of your chronic heartburn. Stress has been considered the culprit in a variety of gastrointestinal problems, including ulcers and inflammatory bowel diseases. But other causes play a role, too.

Stress and GERD

Even if excess weight, smoking, alcohol, or other GERD-triggering factors cause your heartburn, stress may make you feel the symptoms of acid reflux more acutely.

"Stress can affect many gut functions, and we know that patients who are under a lot of psychological stress suffer from more severe reflux symptoms—without necessarily having more severe reflux," Mitchell Cappell, MD, Ph.D., the chief of gastroenterology at Beaumont Hospital in Royal Oak, Michigan, said. "We live in stressful times, and heartburn is incredibly common," Dr. Cappell said.

In one survey of over 12,000 patients, published in 2015 in the journal Internal Medicine, over 45% of participants noted "feelings of continued stress" as a common lifestyle factor of GERD. And a study published in the journal Cureus in 2021 explained that stress could disrupt normal GI functioning. The study examined the correlation between anxiety, depression, and GERD.

Another study published in 2018 in the Journal of Neurogastroenterology and Motility examined the connection between anxiety, depression, and GERD. The study discussed previous literature that addressed increased severity of reflux symptoms with stress. The authors also noted that stress has the potential to exaggerate the sensation of reflux symptoms.

The study demonstrated higher GERD levels in those with anxiety and depression. The authors concluded treatment of GERD should be a multidisciplinary approach that encompasses psychological treatment, too, necessary.

In addition, it's known that people who are stressed can have a drop in levels of hormone-like substances known as prostaglandins, which can help coat the lining of the stomach and protect it from acid, said Jonathan Schreiber, MD, a gastroenterologist at Mercy Medical Center in Baltimore.

"Once you are under stress, prostaglandin levels go down," Dr. Schreiber said. Certain drugs block the production of prostaglandins, including anti-inflammatory drugs such as ibuprofen and naproxen, which is why this common class of drug is often a cause of stomach problems, including nausea and ulcers.

The bottom line? "There is a strong connection between stress and acid reflux," Dr. Schreiber said. GERD symptoms are equally real regardless of whether the body and mind sense them.

Stress Reduction Is Key

Reducing stress can ease heartburn and other gastrointestinal problems, but this is easier said than done, Dr. Schreiber said. "I often tell patients if I could write a prescription to relieve stress, I would write myself one first."

There are, however, things that people can do to alleviate stress that may help lessen heartburn. For example, exercise is a great stress reducer. "This doesn't mean running a marathon," Dr. Schreiber said. "It could be walking for half an hour a day. You really need to devote enough time to care for yourself, whether reading a book, going for a walk, or doing yoga." Creative pursuits such as writing, artwork, or music also play a role in stress reduction.

"It's really different strokes for different folks," Dr. Cappell said. "Do whatever it is that calms you. Sometimes it is as simple as listening to music."

Talking to a therapist, clergy member, or even a good friend about your problems can also help mitigate stress, Dr. Cappell said.

Healthy habits go a long way toward combating stress. It's easy to resort to things we know are not good for us, such as smoking and consuming alcohol or excessive caffeine, when times are tough.

And it's no coincidence that these are some of the same things that doctors know increase our risk of heartburn. Caffeine, smoking, and alcohol may relax the lower esophageal sphincter, the muscle connecting the esophagus with the stomach, and allow acid easy access up the food pipe.

If you're under stress, be extra careful to avoid foods that can exacerbate GERD. The National Institute of Diabetes and Digestive and Kidney Diseases lists several foods that can be triggers. These include:

  • Acidic foods, such as tomatoes or citrus
  • Alcohol
  • Chocolate
  • Coffee and other sources of caffeine
  • Foods high in fat
  • Spicy foods
  • Mint

Other tips include making mealtime as relaxing as possible, perhaps by playing soothing music. Eating smaller meals also helps. Don't lie down too soon after eating; try to sleep with your head raised. The National Institute of Diabetes and Digestive and Kidney Diseases suggests eating meals at least three hours before lying down.

If dietary and lifestyle changes don't reduce your symptoms enough, medications can also help combat GERD. Examples of medications, per the National Institute of Diabetes and Digestive and Kidney Diseases, include antacids, H2 blockers (these lower the amount of acid in your stomach), and proton pump inhibitors (these lower the amount of acid your stomach makes).

A Quick Review

Stress may negatively impact symptoms of GERD. However, lifestyle and dietary changes can help reduce symptoms. Medications are also available when lifestyle changes aren't enough. And, if you think you may be experiencing GERD or having increased symptoms, reach out to a healthcare provider for advice. They can help you determine an appropriate treatment plan.

Was this page helpful?
Related Articles