Can acid reflux cause nausea?

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Vomiting and feeling nauseous after eating happens to most people every now and then. This is often caused by eating too much and should go away in about an hour.

However, some people experience nausea after eating more frequently. In such cases, there are usually certain underlying medical conditions that trigger nausea or vomiting.

Sometimes heartburn – a burning sensation around the middle of the chest, a typical symptom of acid reflux – is experienced together with nausea or even vomiting.

Actually, this happens often enough to raise the question: Is there a relationship between acid reflux and nausea?

Acid reflux and nausea

Nausea is a possible, but not typical acid reflux symptom. Vomiting during an acid reflux episode is also possible, but even less common than nausea.

This study examined 10 patients with chronic, intractable nausea who have not responded to traditional empirical therapies.

Doctors applied endoscopic examination of the esophagus, 24 -hour esophageal pH test, gastric-emptying test, etc. Turned out acid reflux was the cause of nausea for all 10 patients.

As the study concludes:

Intractable nausea is an atypical symptom that can occur in a subset of patients with gastroesophageal reflux disease. […] Nausea related to gastroesophageal reflux disease resolves or is markedly reduced with proton-pump inhibitors or promotility drugs.

(source)

Another study examined acid reflux, nausea, and the effectiveness of fundoplication – a surgical procedure to cure reflux. Spoiler: the number of patients with nausea dropped by 79% after the surgery. However, this part of the study is more relevant for us:

Nausea was the most common atypical symptom of gastroesophageal reflux disease, occurring in 33 patients (33%).

(source)

As you can see, acid reflux and nausea can happen together, however, this doesn’t mean that it’s always acid reflux that triggers heartburn and nausea.

Some gastrointestinal issues might cause both heartburn and nausea:

  • irritable bowel syndrome
  • hiatal hernia
  • gastritis
  • celiac disease
  • gastroparesis
  • diverticulitis

It is also common to experience both acid reflux and nausea during pregnancy.

Irritable bowel syndrome

A video about the connection between IBS and acid reflux. Duration: 3:52

Irritable bowel syndrome (IBS) is a digestive problem that causes symptoms like stomach cramps, diarrhea, constipation, etc.

There is no known cure for IBS, patients can manage their condition with the proper diet and lifestyle changes.

IBS is quite common, according to the American College of Gastroenterology:

IBS is a very common disorder and scientific tests show that about 10% to 15% of people in the United States have it. IBS is more common in women with almost twice as many women having it than men.

(source)

There seems to be a significant overlap between people with IBS and acid reflux:

  • this study found that 63.6% of people with IBS also had GERD
  • this study concluded: IBS, gastro-oesophageal reflux symptoms, and bronchial hyper-responsiveness occurred more frequently together than expected

IBS and acid reflux overlap so much, that scientists think there must be some underlying condition, that causes both.

Nausea is also a common IBS symptom, especially in women.

Hiatal hernia

A short video by Mayo Clinic about hiatal hernia and acid reflux. Duration: 2.23

When the upper part of the stomach extends through the diaphragm into the chest, we talk about hiatal hernia.

Hiatal hernia is quite common, according to the Baylor College of Medicine:

Statistics reveal that 60% of adults will have some degree of a hiatal hernia by age 60, and even these numbers do not reflect the real prevalence of the condition because many hiatal hernias can be asymptomatic.

(source)

A hiatal hernia often doesn’t cause any symptoms.

However, in some cases, it might relax the lower esophageal sphincter (LES). This muscle sits between the esophagus and the stomach. When the LES is tight, nothing from the stomach can flow back into the food pipe.

A relaxed LES makes acid reflux episodes very likely, therefore heartburn is a common symptom of hiatal hernia.

According to the University of Michigan, not only heartburn but nausea and vomiting is also a possible symptom of hiatal hernia.

Gastritis

A short but informative video about gastritis. Duration: 3:02

Gastritis is the inflammation of the stomach lining.

Gastritis is often caused by Heliobacter pylori infection, nonsteroidal anti-inflammatory drugs (NSAIDs), but the risk also increases with age. Unhealthy food, smoking, and stress might also be the cause.

Common symptoms of gastritis:

  • heartburn
  • nausea and vomiting
  • feeling full
  • belching
  • stomach pain

Celiac disease

Celiac disease or gluten allergy is an abnormal immune system reaction to the proteins in wheat, barley, and rye.

According to a study on the Celiac Disease Foundation website:

The results were clear: nausea and vomiting accompany acute immune reaction when people with celiac disease eat gluten.

(source)

This study found that acid reflux or GERD symptoms are also common in untreated celiac disease patients. However, rapid improvement can be achieved with a gluten-free diet.

Looks like, if you have celiac disease, but manage to keep a gluten-free diet, you are not more likely to suffer from nausea and heartburn than the healthy population.

Gastroparesis

Gastroparesis means delayed gastric emptying or decreased stomach motility. In plain English, this means food stays longer in the stomach than it should.

Possible causes are diabetes, surgical complications, certain medications (e.g. antidepressants, calcium channel blockers), etc.

Common symptoms of gastroparesis:

  • heartburn
  • nausea and vomiting
  • bloating
  • abdominal pain
  • feeling full after eating a small amount

There is no cure for gastroparesis, a healthy diet can make the condition manageable. E.g. ginger is known to promote gastric motility.

Regurgitation vs vomiting

It is important not to confuse regurgitation, which is a typical acid reflux symptom, with nausea and vomiting, which are less common symptoms.

Regurgitation happens when stomach contents flow back (reflux) into the throat and mouth. There are usually no warning signs, regurgitation is sudden and unexpected.

However, vomiting has a warning sign – nausea -, people usually know when they are about the throw-up.

Final thoughts

Nausea and vomiting are atypical acid reflux symptoms, they are not uncommon during reflux attacks.

However, this doesn’t necessarily mean that acid reflux can cause nausea. It is quite possible that some other gastroenterological condition causes both typical acid reflux symptoms – like heartburn – and nausea or vomiting.

The bad news is that often these health problems cannot be cured. Sometimes surgery might be a solution, medications usually treat the symptoms, not the underlying causes.

The good news is that with the proper diet and a healthy lifestyle most people can manage their conditions.