Acid reflux causes anxiety

How to Deal With Anxiety and Heartburn

Many of the symptoms of anxiety cause further anxiety. The cyclical nature of anxiety is one of the reasons that this disorder can be hard to treat without some type of outside intervention. You experience anxiety, then you experience very frightening symptoms, and then you experience more anxiety over those symptoms.

This is the case with anxiety and heartburn. Heartburn, also known as acid reflux, can cause numerous symptoms that may lead to significant anxiety, especially if you are prone to health anxiety or panic attacks.

Heartburn and Anxiety

The relationship between anxiety and heartburn is not an obvious one. Not everyone experiences heartburn when they’re stressed, and others may be experiencing symptoms of mild hyperventilation which can mimic heartburn symptoms (such as chest pain) and are very common with anxiety.

It’s not always as simple as saying “anxiety causes heartburn.” There are several potential causes of heartburn from anxiety:

  • Gastroesophageal Reflux Disease (GERD) Many of those that suffer from heartburn when they have anxiety also have GERD, otherwise known as “acid reflux disease.” Many people live with mild GERD, and one of the factors that causes an increase in GERD symptoms is anxiety. GERD is generally a non-dangerous disease, although the symptoms of GERD may be triggers for panic attacks.
  • Stomach Pressure One of the issues that causes heartburn/acid reflux is pressure around the muscles of the stomach. This is linked to the fact that a common symptom of anxiety is muscle tension. Therefore, it’s easy to see how anxiety can potentially push acid up in the stomach and cause the symptoms of heartburn.
  • Excess Stomach Acid It appears that stress increases stomach acid buildup. For many, this can cause issues not only with heartburn, but also appetite. Despite the increase in stomach acid, it’s not terribly common for those symptoms to cause heartburn (they often cause indigestion and stomach discomfort, however). Nonetheless, this does happen in some people.
  • Changes in Digestion Stress is known to affect the digestive process both in the intestines and in the stomach. It’s possible that anxiety is causing your body to digest food poorly, leading to acid buildup in the stomach that moves up the esophagus. Anxiety may also slow down digestion, leading to similar issues with food moving down the esophagus.

Stress can also affect your hormones and your body’s efficiency. Thus, many people with anxiety may have a lower esophageal sphincter (the sphincter that controls acid reflux) that works improperly as a result of anxiety.

Is Anxiety Heartburn Dangerous?

Heartburn, in general, is not dangerous per se. However, there are some risks. For example, both stress and heartburn can lead to ulcers, and ulcers can be dangerous. GERD has a very low chance of causing long term disease. The problem is not just the danger, however. The problem is that the symptoms of heartburn often lead to further anxiety.

This is especially problematic if you have panic attacks. Some of the symptoms of heartburn include:

  • Stomach discomfort.
  • Chest pain.
  • Difficulty swallowing.
  • Chronic cough.

The first three symptoms are known to be triggers for panic attacks. The last symptom can cause hyperventilation if the coughs are too frequent or too hard, and hyperventilation can lead to panic attacks.

Treatment Options for Heartburn From Anxiety

Traditional heartburn treatments only have a moderate effect on anxiety heartburn. Eating smaller meals, taking antacids, and eating foods that do not contribute to heartburn are a good place to start. But they’re only going to do half the job, as many people that experience heartburn from anxiety fail to get complete relief when they utilize these treatments alone.

Some of those with anxiety claim to get relief from jogging and other forms of exercise. However, it should be noted that in general, exercise actually makes acid reflux temporarily worse. In the long term, though, it helps a lot with heartburn. While these options may prove helpful, there is one thing that should be considered first by people looking to get rid of their heartburn anxiety: address the root of the problem by treating your underlying anxiety!

What’s the Connection Between Anxiety and Acid Reflux?

Heartburn, belching, nausea — everybody feels the symptoms of gastroesophageal reflux disease (GERD) from time to time. But do those symptoms come from an actual medical issue? Or are some patients just extraordinarily sensitive to small changes in their digestive tract?

A new study suggests that the answer might depend on the patient’s mental health.

Fernando Herbella, MD, a gastroenterologist at the Federal University of São Paulo in Brazil, and his colleagues examined 222 patients who all 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.

Then the researchers observed the pH values in each patient’s esophagus, because an acidic pH value is a common indicator of GERD. They found that nearly half the patients who reported having anxiety and depression had normal pH values in their esophagus — indicating that they most likely did not have GERD.

Are these patients exaggerating the symptoms they feel, or feeling symptoms more acutely? Dr. Herbella believes it’s the latter. “Patients with anxiety and depression or other mental health issues display a ‘hypervigilance’ or ‘hypersensitivity’ to pain sensations,” he says.

In the case of GERD, an extremely common — and usually mild — digestive health problem that affects about 3 million Americans every year, this hypervigilance has curious effects on patient perception. The study found an inverse relationship between anxiety levels and esophagus pH; the more anxious the patient was, the less damaged their esophageal lining. And they found that depression was directly related to esophagus pH — but only in women.

“I really couldn’t even venture a scientific explanation for that,” Herbella says.

The findings, presented at Digestive Disease Week 2018, illustrate just how much psychiatric disorders complicate GERD treatment and diagnosis.

Psychiatric Disorders and Pain Perception

Vic Velanovich, MD, a gastrointestinal surgeon and one of the study’s co-authors, says this is not an isolated phenomenon. It’s 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. So anything happening in the frontal cortex, including mental disorders, makes pain perception worse.”

Velanovich has been exploring the effects of the pain-modulation network for some time. In 2001, he published a study examining whether psychiatric disorders affected patient satisfaction with GERD-correcting surgery. He found that surgery satisfied 93.5 percent of patients without psychiatric disorders, and just 11.1 percent of patients with them.

“It was a classic ‘nocebo’ effect,” Velanovich says. “For both groups of patients the GERD pain was greatly relieved. But only anxious patients found the aftereffects of the surgery intolerable. Which tells me that there’s something else going on.”

This research illustrates how fraught the diagnosis and treatment of GERD can be for gastroenterologists. “The biggest point is that clinicians can’t rely on patient-reported symptoms to diagnose GERD,” Herbella says. “And they certainly shouldn’t skip right ahead to treatment just because a patient is raising complaints. Always look for objective physiological measures before making a diagnosis.”

He also suggests that some of the onus lies with primary care physicians, who he says should be careful to observe any psychiatric issues that occur alongside GERD symptoms.

Velanovich agrees. “My suspicion is that patients with these psychiatric problems are hunting for a physiological cause for some discomfort that they have.”

But he’s careful to emphasize that this is not the patient’s fault. “It’s not a moral failing! People with mental disorders often have little control over their conditions. But it’s important not to give these patients unnecessary treatment that could potentially do them harm. That’s why patients and physicians need to be careful.”

GERD/Reflux = Panic Attacks?: So in November… – Anxiety Support

So in November of 2015, I had my first panic attack. It scared me, to say the least. Three doctors later and a good therapist later, I was doing much better. The doctor at the Med Center I went to in November said that I had acid reflux and that is what caused my panic attack. I am still dumbfounded by this assertion but I have tried to accept it. Even with acceptance, I seemed to have developed this nasty case of GERD/Reflux beginning in January that is very noticeable with extreme belching. I sometimes get nasty pains in my stomach and in my lower bowels. It’s annoying and it messes me with me but I try to just focus on the positive and use some techniques I learned in therapy to get through it.

After my first panic attack, I ended up in the ER 3 more times because of panic attacks. I did not have heartburn at the time but I would get the same sensations of my chest and arm hurting and radiating up in my jaw. Each time, did the whole blood work up and EKG, and I was fine.

I made some big lifestyle changes to help with my anxiety.

I started working out again and I have been successful in losing some weight. I need to lose about 10 more pounds but I am down about 25 pounds total since November. I do get some anxiety about working out. The panic attacks brought out some terrible health anxiety related to my cardiovascular system. I think that train of thoughts come from the fact I thought i was having heart attacks when I was having panic attacks so I am worried about having a heart attack. I am 32 and my doctors way that I am totally fine, which is helpful but not completely.

I was taking pepcid AC and my doctor told me to try Prilosec. This seemed to help but I finished the 14 day dose so I didn’t want to go past that before seeing my doctor. I have a GI appt scheduled for April 2nd.

In any event, I went to a BBQ fest yesterday and had one pork sandwhich and a beer. Beer and liquor do not seem to affect me in regards to reflux. I drink socially once or twice a week. No more than 4 drinks at a time. I eat very healthy and I watch acidic foods and do my best not to compound my alcohol use with fried foods and other stuff like garlic and tomatoes that give me heartburn. But none the less I think I made a mistake in my lunch choice.,

So last night at about 12:20 a.m. , I woke up and my eyes were blurry and my heart was racing and I was trembling in my arms and legs. I did feel some heartburn when I went to bed but nothing that was debilitating. I got out of bed and woke up my wife because this hasn’t happened in some time. I kept thinking my one pupil was bigger than the other. They both were quite dilated and my heart rate was like 130 when it is usually in the high 60’s to to mid 70’s.

I wasn’t stressed at all on Saturday. I had some face tingles and stuff like that, that i have become accustomed to with this anxiety situation I have, which sometimes does flip me out a little bit but I try to stay calm. Therefore, I was shocked when I seemed to have another panic attack last night after a nice day out with my friends.

My question to this forum is, Has this happened to anyone else and did you ever get a diagnosis? To expound on my question, is it possible to have reflux trigger a panic attack or anxiety attack like that? I was able to calm myself down and I got some sleep but it freaked me out. I had been doing so well and this is really the first episode I have had in over a month.

In addition, my therapist who is a PH.D in psychology and specializes in CBT doesn’t want to label me. I haven’t quite figured this out yet but I have read so much that Generalized Anxiety Disorder and GERD/Reflux are strong bed fellows. I mean at 32 you try to figure out who you are and this panic attack situation is just bizarre because I never had one in 32 years prior to this. I never had reflux, I never had panic. My primary doctor things I have a panic disorder. He tried pills (zoloft and prozac) but they made my mental state worse. Zoloft made me feel so high that I sat and ate a bag of grapes. Like a whole bag of grapes and Prozac made me contemplate all sorts of things I do not want to thing about ever again.

I am trying to stay positive but waking up terrified isn’t funny especially with a five year old daughter and a pregnant wife.

Any insight would be greatly appreciated. Thank you again!

You might have acid reflux

The healthy habits that can cause reflux

One possible explanation for GERD: your sparkling water habit. Carbonated beverages tend to relax the bottom of the esophagus, per Gupta. When the lower esophageal sphincter (LES), a muscle at the entrance of your stomach, is relaxed, acid from your stomach can pass back up into the esophagus. If it happens often, it gets diagnosed as GERD (gastrointestinal reflux disease).

Other popular drinks that have the same effect include coffee (caffeine is a trigger), energy drinks (a double whammy as they’re often carbonated and caffeinated), and alcohol of any sort. You shouldn’t go cold turkey on any of these delightful things if you’re not experiencing symptoms. But you should partake in moderation. “People think they’re doing a good thing by drinking sparkling water as a way to stay hydrated, but there is such thing as too much of a good thing,” says Gupta.

The anxiety-stress connection

Here’s where things got even more interesting to me. I came across several articles and studies that linked reflux to anxiety, stress, and depression. As someone who has dealt with anxiety since freshman year of college, I was immediately intrigued—it would make total sense that anxiety was the culprit behind this sudden onset of reflux.

A 2017 study in the World Journal of Gastroenterology concludes: “Psychological factors, including anxiety and depression, play an essential role in the development of GERD and especially that of NERD (nonerosive reflux disease).” Other studies have suggested that anxious or depressed people or more likely to develop reflux symptoms. This Swedish study from 2007 found that people with anxiety had a 3.2-fold increased risk of reflux symptoms while those with depression had a 1.7-fold increased risk.

When I asked Dr. Morrison about this, he wasn’t surprised. “In New York City, most people would admit that they are generally running on adrenaline, keeping their energy levels up, stretching the day to its longest amount of time,” he said. “Running on adrenaline and stress means that they’re running on fight or flight, or the sympathetic nervous system.” That’s a problem because your digestive tract does not activate in fight or flight. “It’s evolutionary, you’re not supposed to be digesting your food when you’re running away from a tiger which is what that system was designed to help you do,” says Morrison. “If a person is not digesting properly, then the food just sits in the stomach, and then keeps on refluxing back up.”

Acid reflux, also known as heartburn– that horrible burning feeling in the center of your chest – can has many physical and emotional causes. Obesity, age, eating habits and a history of hiatal hernia can cause acid reflux. But did you know that anxiety can also contribute to the condition? Being stressed or anxious causes an increase in stomach acid, which in turn can trigger acid reflux.

Understanding Acid Reflux

The stomach constantly produces acid to break down foods. Acid reflux occurs when the acid produced in the stomach reaches the esophagus. The esophagus connects to the entrance of the stomach, where a muscular ring (called the lower esophageal sphincter, or LES), opens to let in food.

The LES should close immediately after the food enters the stomach, but when that muscular ring malfunctions, the stomach acid can enter the esophagus, causing that familiar burning pain. Physicians diagnose people who experience heartburn more than twice a week with gastroesophageal reflux disease (GERD).

The Anxiety Connection

When people are stressed or anxious, they often feel those emotions in their stomachs. Receiving bad news, worrying about finances or a loved one, even watching the evening news can cause the acid production in the stomach to ramp up, because emotions impact several aspects of the digestive system.

  • Pressure – Stress doesn’t just increase a person’s blood pressure; it also causes the gastric muscles to contract. This pushes the contents of the stomach along with the stomach acids toward the LES. All that churning sometimes leads to reflux.
  • Acid overproduction – When the brain struggles to cope with stress, it has less energy left to regulate body systems. This can cause some parts of the digestive system to shut down and others to go into overdrive. Many people’s stomachs produce more acid when they’re anxious and this can cause them to experience heartburn.
  • Digestive disturbances – Anxiety triggers the same hormones that regulate the digestive system. Stress throws the system out of balance. Food moves more slowly through the system and the body can’t absorb key nutrients.

A Vicious Cycle

Heartburn hurts, and pain causes stress. Patients with acid reflux may be reluctant to eat properly due to throat discomfort. They don’t eat to avoid triggering more acid overflow into the esophagus. Sleeping in a flat position can also allow acid to flow past the LES, with the discomfort of heartburn causing sleep disturbances.

Stop Heartburn for Good

Some people are able to successfully treat GERD with lifestyle and diet changes or medications. For many people, however, these changes don’t stop reflux, they just lessen the symptoms. Acid reflux surgery can stop GERD for good by correcting the problem at its cause—the weakened lower esophageal sphincter. Dr. Preeti Malladi is a skilled surgeon who can help you live every day without the pain of acid reflux. Get in touch to schedule an appointment today.

FAQS About Heartburn

What is heartburn?

Heartburn occurs when stomach acids reflux, or flow up, into the esophagus. Prilosec OTC® is only indicated for the treatment of frequent heartburn. If you think you may have any of the symptoms described below, please talk to your doctor or healthcare provider.

What is the difference between heartburn and frequent heartburn?

Frequent heartburn is defined as heartburn occurring two or more days a week. Prilosec OTC is formulated for frequent heartburn.

Why do stomach juices irritate the esophagus?

These juices, which are produced by the stomach to help the body break down food, contain a powerful acid called hydrochloric acid. While the stomach is naturally protected from this potent acid, the esophagus does not share the same protective qualities as the stomach. So, if acidic stomach contents come into contact with the esophagus, the esophagus’ skin-like lining can be irritated or injured and result in the sensation known as heartburn.

What causes heartburn?

Heartburn is caused when stomach acid enters the esophagus. When functioning normally, the LES opens like a one-way valve that allows food into the stomach, but does not let it out the same way. However, at times the LES relaxes and allows stomach juices to flow upward into the esophagus. This relaxation exposes the esophagus to harsh acid from the stomach. Physicians refer to this as gastroesophageal reflux.

What is GERD?

GERD, or gastroesophageal reflux disease, is chronic, persistent heartburn, and results from the improper working of the ring of muscle that normally keeps food and acids inside the stomach. When this muscle doesn’t work correctly, it allows acids to back up into the esophagus. Other signs of GERD include: regurgitation, difficulty swallowing, coughing, hoarseness, and a lump feeling in your throat. In some instances, these ailments surface even when heartburn’s usual symptoms are absent. This can lead patients to misunderstand these conditions because people with ear, nose, and throat (ENT) complaints often do not have heartburn symptoms. Prilosec OTC is only indicated for the treatment of frequent heartburn. If you think you may have GERD, please talk to your doctor or healthcare provider about having a diagnostic screening test.

What is the difference between heartburn and acid reflux?

Acid reflux, or gastroesophageal reflux disease (GERD), is a chronic condition that causes a person’s liquid stomach contents—stomach acids, pepsin, and bile—to back up into the esophagus. Heartburn is the result of this action, but heartburn may also be a sign that some other trigger is at work. Just because you have heartburn, it does not necessarily mean that you have acid reflux. Acid reflux is a chronic condition characterized by irritation or inflammation of the esophagus. Some of the common symptoms of acid reflux include: chronic, persistent heartburn; regurgitation; drastic weight loss; discomfort and difficulty swallowing; coughing often; severe hoarseness or wheezing; a feeling of a lump in the throat; and interference with lifestyle or daily activities. If you think you may have this condition, speak with your healthcare professional about a diagnostic screening test. If left untreated, acid reflux can cause or contribute to a range of more serious health issues, such as ulcers of the esophagus and chronic coughing.

What is esophagitis?

When stomach acids repeatedly back up into the esophagus, they can injure the esophagus’ sensitive lining. That injury can lead to uncomfortable inflammation called esophagitis. Eventually, the acid wears away at the esophagus, causing bleeding. If the bleeding is heavy enough, blood can pass into the digestive tract and show up as dark, tarry stools. Esophagitis can cause ulcers—sensitive, open sores on the lining of the esophagus. In a small percentage of people, long-term acid exposure from GERD leads to a condition called Barrett’s esophagus (BE). In BE, new cells form to take the place of those damaged by acid reflux.

Are heartburn at day and heartburn at night different conditions?

Both heartburn at day and heartburn at night result from stomach acid reflux. However, lying horizontally to sleep at night makes it more likely you will experience more stomach acid reflux than when sitting up or standing.

What are some common treatments for heartburn?

Antacids: Antacids neutralize the acid in your stomach. Antacids are commonly taken after you eat or when pain begins. Antacids provide immediate, temporary relief.

H2 Blockers: H2 blockers relieve heartburn symptoms by reducing acid production. They begin working within an hour and can last for 12 hours. H2 blockers begin working relatively quickly, but may not block heartburn as long with a single pill when compared to PPIs.

Proton Pump Inhibitors: When you eat, millions of tiny pumps in your stomach produce acid to break down food. Heartburn occurs when these excess acids reflux into your esophagus. PPIs (such as Prilosec OTC) work by directly blocking many of these pumps. A PPI may take one to four days for full effect, but it can effectively block frequent heartburn for 24 hours with just one pill a day for 14 days.

Are there certain foods that cause heartburn?

Yes, there are common foods and lifestyle factors that cause heartburn to flare up, and these are known as heartburn triggers. Paying attention to your body and how it reacts to these triggers helps you make smart choices:

  • Citrus fruits

  • Spicy foods

  • Chocolate

  • Garlic

  • Onions

  • Fatty foods

  • Tomatoes or tomato-based products

  • Peppermints

  • Black pepper

  • Vinegar

  • Caffeinated or carbonated beverages

  • Alcoholic beverages

Are there steps I can take to fight frequent heartburn?

Yes. There are several lifestyle choices, all of which contribute to reduce the chance of frequent heartburn.

Reduce stress: Stress can contribute to heartburn and make you more likely to overeat. Make time for yourself, prioritize responsibilities, and try to keep things in perspective to reduce stress in your life.
Exercise regularly: It will help you manage stress and keep you healthier overall. Exercising also helps you sleep better. Talk to your doctor before you start any exercise program.
Control portions: Decrease the size of portions at mealtimes. Your stomach won’t need to produce as much acid as with a big meal, and less acid means less chance of acid reflux.
Stop smoking: Smoking relaxes the valve at the top of your stomach, allowing excess stomach acid to reflux into your esophagus.

Do I have to give up everything I love to control my heartburn?

With good advice from your healthcare professional, you should be able to develop a healthy plan to help control your heartburn. A healthy plan will let you keep eating the foods you love and continue doing your usual activities. Given the many recent advancements in our understanding and treatment of heartburn, even the most severe heartburn sufferers generally find that they can control their heartburn through heartburn medications and some simple lifestyle changes.

What does heartburn have to do with heat?

Many heartburn sufferers experience the burning sensation known as heartburn and associate the discomfort with intense heat. However, the discomfort is not caused by temperature but by the irritation resulting from the presence of acid in the esophagus.

How does stress contribute to heartburn?

Gastrointestinal symptoms have long been associated with stress, fear, and anxiety. The perception of heartburn can increase during stress. Numerous clinical studies confirm the correlation between stress and heartburn.

Stress also can contribute to reflux by causing heartburn sufferers to engage in behaviors that trigger acid production (i.e., turning to high-fat comfort foods, smoking, drinking caffeine, or eating late at night). Stressful life events (anxiety, tension, and stress) can increase sensitivity to refluxed acid, reducing the threshold for pain and increasing the frequency and/or severity of heartburn symptoms. In addition, stress may increase a person’s sensitivity to the pain caused by a heartburn episode.

June 5, 2015 — If promising but early studies pan out, psychiatrists of the future could make a most unusual request of their patients: a sample of their stool.

Yes, the bodily specimen used to help diagnose digestive diseases might also offer clues as to what’s happening at the other end of someone’s anatomy.

Intriguing research, done mainly in rats and mice so far, suggests that bacteria that live in the gut influence brain development, mood, and behavior. Someday, doctors might be able to treat mood disorders with probiotics, supplements containing good gut bacteria; prebiotics, which promote the growth of good bacteria in the gut; or highly specific antibiotics that kill bad gut bacteria.

Depression “clearly isn’t all about Prozac and serotonin,” says Roger McIntyre, MD, who directs the Mood Disorders Psychopharmacology Unit at the University of Toronto. “We need to look at alternative explanations, alternative treatments.”

And at least for some people with a mental illness, a major contributing factor might be the 100 trillion bacteria — “aliens,” as Dartmouth microbiologist and immunologist Lloyd Kasper, MD, calls them — that live in the gut.

Scientists call this two-way street the gut-brain axis, and they’re just beginning to learn how the two organs talk with each other. “We’re so far at the tip of the iceberg on this that we don’t know where it’s going to go,” Kasper says.

Babies are born with sterile guts, but bacteria begin moving in within hours. The bacteria population remains relatively stable from age 3 onward, but things like environment, diet, drug exposure, and genetics can influence which ones thrive, McIntyre says.

Healthy people tend to have similar types and proportions of gut bacteria. Changes in the gut bacteria have been linked not only to digestive disorders but also to metabolic and brain disorders, says Jane Foster, PhD, an associate professor of psychiatry and behavioral neurosciences at McMaster University.

In an interview, Foster described several possible ways that gut bacteria and the brain communicate.

One is via the enteric nervous system, the part of the nervous system that governs the digestive tract. Also, gut bacteria can alter how the immune system works, which can affect the brain. The gut bacteria are involved in digestion, too, and the substances they make when they break down food can affect the brain.

And under certain conditions, such as stress or infection, potentially disease-causing gut bacteria, or bad bugs, can leak through the bowel wall and enter the bloodstream, enabling them and the chemicals they make to talk with the brain through cells in blood vessel walls. Bacteria could also communicate directly with cells in certain regions of the brain, including those located near areas involved in stress and mood, Foster says. It’s unclear, though, how that might affect your mood.

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