The Connection Between GERD and Anxiety

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.

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. Physical factors such as a weak or injured lower esophageal sphincter, delayed stomach emptying, abdominal distention (such as in pregnancy), presence of Helicobacter pylori, increased stomach acid content, hiatal hernia, and more can cause GERD.

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:

• Esophagitis
• Esophageal stricture
• Barrett’s esophagus
• 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.

Medications to avoid in treating anxiety and GERD include:

• Tricyclic antidepressants: These have been shown to lower esophageal sphincter pressure.
• Selective serotonin reuptake inhibitors (SSRIs): These impair esophageal motility, which can lead to episodes of acid reflux.
• Benzodiazepines: These can lower the body’s pain threshold, which may increase a person’s sensitivity to and painful perception of reflux symptoms.

Serotonin-norepinephrine reuptake inhibitors (SNRIs) are another medication that is commonly used to treat anxiety, which has not been shown to worsen GERD symptoms. It is important to discuss the best medication for you with your healthcare provider, taking into account your personal history and unique situation.

Healthcare providers use 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
• Fundoplication surgery

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
• Avoiding trigger foods
• Reducing stress
• Progressive relaxation
• Yoga
• Meditation
• Sleep hygiene

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.