Does Anxiety Cause Acid Reflux?
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Everybody gets heartburn from time to time. But if it becomes chronic — defined as two or more times per week — you may have gastroesophageal reflux disease (GERD).
Experts say that the relationship between GERD and anxiety is complex and circular.
“If you’re in discomfort anywhere in your body, that is stressful,” says Stephen Lupe, PsyD, a gastrointestinal psychologist and director of behavioral medicine in the department of gastroenterology, hepatology, and nutrition at the Cleveland Clinic in Ohio. “And that stress can then exacerbate what’s already going on physically.”
GERD and Anxiety: What Causes the Link?
Researchers say that many factors are at play that may explain the association between anxiety and GERD, particularly when it comes to the effects of stress on the gastrointestinal tract.
Other research suggests that patients with mental health issues like anxiety may be more sensitive to small changes in their digestive tract. For example, one study examined more than 200 patients who suspected they had GERD. Each patient took a 14-item questionnaire to test for anxiety and depression. Some of the patients had these mental health issues and others did not.
Were patients exaggerating the symptoms they felt, or were they feeling symptoms more acutely? Researchers believe it’s the latter. “Patients with anxiety and depression or other mental health issues display a hypervigilance or hypersensitivity to pain sensations,” says Fernando Herbella, MD, a gastroenterologist at the Federal University of São Paulo in Brazil and one of the study’s authors.
Indeed, this heightened level of sensitivity maps to a condition known as reflux hypersensitivity — more on that below.
Psychiatric Disorders and Pain Perception
Vic Velanovich, MD, a gastrointestinal surgeon at USF Health in Tampa, Florida, and another one of the study’s authors, says this is not an isolated phenomenon but part of a broader problem in assessing the severity of disease. “It’s always very difficult to correlate patient-perceived symptoms with actual physiological measures,” he says.
Dr. Velanovich offers a neurological explanation. “It’s called the pain modulation network. Pain is converted to electrical signals that travel to the brain. It’s interpreted there by the frontal cortex,” he says. “So anything happening in the frontal cortex, including mental disorders, makes pain perception worse.”
However, experts emphasize that this is not the patient’s fault, and in no way is it “all in their heads.”
“This is just how complicated human beings are,” Dr. Lupe says. “As you put the system under stress, there is more dysfunction within the system as a whole, and that means we’re going to interpret the things that are going on in our body as more threatening. That doesn’t mean it’s in your head — those are real problems happening in our body.”
He likens it to an engine running at 5,000 revolutions per minute. “There’s nothing wrong with the engine when it starts to have some problems,” he says. “It’s just the stress of running it that high can cause some problems. It’s the same thing inside the human body. That’s why we see stress is linked to all health conditions.”
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