Stress- The reason your GERD is not improving even after being on medications?
Inside – What is Stress? How stress contributes to GERD. 4 Ways to Reduce Stress for GERD. And treatments for GERD.
Heartburn or GERD is a common condition that people suffer from worldwide. Sometimes the symptoms are short-lived and people get rid of it easily but for some people, the symptoms persist for a long time. What we want to explore here is that Can stress cause heartburn?
These are the people who start taking acid suppression medications, sometimes their symptoms improve and sometimes they don’t. It is estimated that about 40% of patients with GERD symptoms do not respond to acid suppression medications like PPI. So can stress management be the answer to improve their heartburn symptoms?
What is Stress?
The way I define stress is — anything that you as a person is not comfortable with. Whether it is emotional, mental, physical or spiritual or any other condition that you get exposed to. With our modern day life, we all get stressed out whether it is our work, personal life, health or things around us. Stress affects us in a lot of different ways and now we know that it is related strongly to GERD.
How Stress Contributes to GERD
Stress through various effects on our body contributes to the problem of GERD. One study showed that Acute stress interfered with the oesophagal motility (or food pipe mobility in common terms).
In a recent study, it was seen that some people in a stressful situation had impaired motility of their food pipe (oesophagus) and causes slower clearance of food and acid from the oesophagus which in turn can lead to GERD symptoms.
Another study showed; People who have been chronically exposed to stress, perceive higher painful reflux symptoms as compared to other people. The level of symptoms that people perceived didn’t correlate with the amount of reflux they had, so it was thought that stress caused people to perceive more pain than others [see reference -3,4]. Stress can also contribute to GERD by increasing the mucosal permeability of the esophagus .
Contrary to popular belief the studies have shown that chronic stress can reduce gastric acid production, and that interferes with proper digestion and leads to reflux symptoms [5,6].
This is probably the reason that in a significant number of people the GERD symptoms don’t get better with acid suppressant medications; because their actual problem is low acid rather than high acid.
An interesting experiment was conducted where they removed the adrenal glands from rats and exposed them to stress and measured their acid levels. Adrenal glands are your stress glands which secrete cortisol ( a stress hormone), when your body perceives stress. The researchers observed that there was no reduction in acid production in rats where adrenal were removed, while in normal rats the acid production reduced with stress exposure, demonstrating that stress can reduce acid production. The underlying mechanism of how stress reduces stomach acid production seems to be through regulating the NO ( nitric oxide) synthesis in vagus nerve.
So for a lot of people stress might be the underlying cause of their GERD symptoms and it should be a priority to use techniques that can help your body to deal with stress in a better way.
Related Read: Comprehensive GERD Treatment.
4 Ways to Reduce Stress for GERD Treatment
- Meditation: There are so many different kinds of meditation practices and the best part is all of them work. What I tell my patients is to follow the practice that resonates for them. It’s always good to start with guided meditation whether it is following a voice prompt or nature’s sounds. It never hurts to take some online courses or training for meditation; as there is a learning curve for the meditation. I do a meditation practice everyday which is called Heartfulness and I recommend everyone to try it as it is so easy to do. You can try free of cost by following this link.
- Exercising: Physical exercise can also help with reducing stress. So regular exercise daily basis for 20-30 minutes should help you with relieving stress. Again different kind of exercises have different benefits, but I suggest to keep it interesting for yourself and do the one that you enjoy the most.
- Yoga: Yoga can be a part of your regular exercise regimen also, as there are practices which are intense and can give you a good workout. But if you are looking for just stressbuster than a gentle yoga practice will be most beneficial.
- Nature: Being in nature is so much stress relieving. Majority of us spend time indoors in front of the computer and away from nature, so just spending some time in nature will help a lot. Whether that means during your break go for a short walk outside, or on weekends, spending time with your family connecting in nature, either hiking or a picnic outside. Nature as so many healing properties, that once you spend time outside you feel revitalised.
Here we try to answer the question can stress cause heartburn. The research supports that stress or anxiety is a major cause of GERD and one of the most often overlooked causes for heartburn. But it is very important to pay attention to stress especially in people where the acid suppressant medications have not been working. We also discussed some natural remedies to deal with stress better, which in turn will help with your GERD symptoms.
Related Post: GERD Diet Plan
- GRubin J, Nagler R, Spiro HM, Pilot ML. Measuring the effect of emotions on esophageal motility. Psychosom Med. 1962;24:170–176
- Peterson WL. The role of acid in upper gastrointestinal haemorrhage due to ulcer and stress-related mucosal damage. Aliment Pharmacol Ther. 1995;9:43–46. doi: 10.1111/j.1365-2036.1995.tb00783.x
- Wright CE, Ebrecht M, Mitchell R, Anggiansah A, Weinman J. The effect of psychological stress on symptom severity and perception in patients with gastro-oesophageal reflux. J Psychosom Res. 2005;59:415–424. doi: 10.1016/j.jpsychores.2005.05.012
- Bradley LA, Richter JE, Pulliam TJ, et al. The relationship between stress and symptoms of gastroesophageal reflux: the influence of psychological factors. Am J Gastroenterol. 1993;88:11–19
- J. V. Esplugues, M. D. Barrachina et al. Inhibition of gastric acid secretion by stress: A protective reflex mediated by cerebral nitric oxide.Proc Natl Acad Sci U S A. 1996 Dec 10; 93(25): 14839–14844.
- Florentzson M1, Svensson K et al. Low gastric acid and high plasma gastrin in high-anxiety Wistar Kyoto rats.Scand J Gastroenterol. 2009;44(4):401-7. doi: 10.1080/00365520802624185.
- Na K1, Kim HS1.Adrenalectomy abolishes hypergravity-induced gastric acid hyposecretion.Oncotarget. 2017 May 9;8(19):30700-30705. doi: 10.18632/oncotarget.15408.