Stress and anxiety can manifest in a wide variety of physical symptoms. Headaches, stomach cramps, shortness of breath can all be triggered by stress.
Long-term chronic stress can not only cause heart problems, depression, and sleep problems, but digestive problems and weight gain are also possible symptoms.
How about heartburn? Let’s take a closer look at the relationship between stress and acid reflux:
Stress and the LES
The lower esophageal sphincter (LES) is a muscle between the esophagus and the stomach. Most of the time this muscle is closed tightly, so digestive juices from the stomach cannot seep back into the food pipe.
However, if the LES relaxes for whatever reason, stomach acids can flow back up (reflux) and irritate the lining of the esophagus, causing a burning sensation around the middle of the chest, called heartburn.
When it comes to the stomach, people respond differently to stress. For some people, stress might decrease the LES pressure, which makes acid reflux episodes more likely.
Stress and stomach acid
It feels plausible that stress increases stomach acid production, however, it looks like this mechanism is not as straightforward as we might think:
During the mental stress period, gastric acid output increased in subjects with high scores on the impulsivity scale, but significantly decreased in those with low scores.(source)
Some other studies are suggesting that not all stress are created equal:
… heartburn severity appears to be most responsive to major life events and not an accumulation of more minor stressors or fluctuations in mood. In addition, vital exhaustion, which may in part result from sustained stress, may represent the psychophysiological symptom complex most closely associated with heartburn exacerbation.(source)
Moderate somatic stress inhibits gastric acid secretion. … our results suggest that the inhibition of gastric acid secretion, a defense mechanism during stress, is mediated by a nervous reflex involving a neuronal pathway …(source)
Looks like stress might both increase and decrease stomach acid secretion.
The above studies suggest that impulsive people might respond to stress by producing more stomach acid while others might actually produce less stomach acid.
Severe stress is also more likely to aggravate acid production, while moderate stress inhibits it.
Too much gastric acid
Even if stress increases stomach acid levels for some people, they should have no symptoms as long as the acid stays in the stomach.
Stress is often associated with wrong eating habits. Alcohol, chocolate, or simply eating too much can all trigger acid reflux. If gastric acid levels are high due to stress, reflux symptoms are likely to be more severe.
Too little gastric acid
It might sound surprising, but low stomach acid levels (hypochlorhydria) might trigger acid reflux.
Hypochlorhydria is known to reduce gut motility and slow down digestion, which might increase pressure in the stomach. If the pressure gets too high, the LES might open up and stomach contents are allowed to enter the food pipe, causing heartburn and other symptoms.
If you are interested in more details, please check out our article about constipation, diarrhea, and acid reflux!
So, can anxiety cause acid reflux?
These are the most important factors that trigger heartburn and acid reflux while under stress:
- Poor digestion might lead to gas buildup in the stomach.
- Muscle tension, just like gas, might also increase stomach pressure.
- Relaxed LES, combined with an increased stomach pressure it becomes easier for digestive juices to enter the esophagus.
- Hypervigilance, a condition when one has exaggerated reactions to certain stimuli. In our case, this could mean that even mild heartburn might feel like severe chest pain.
Stress and silent reflux
When stomach acids can flow all the way up to the throat, we talk about silent reflux (laryngopharyngeal reflux, or LPR).
Many people with LPR don’t experience heartburn at all. The typical symptoms are:
According to Cleveland Clinic, being overstressed is one of the risk factors of silent reflux.
This study found that depression is also common in people with silent reflux: “LPR was significantly more frequent in those with depression than in those without”.
The study examined depression in people with silent reflux symptoms and not the other way around. This raises the question: can reflux cause stress?
Reflux and stress, anxiety, depression
It seems quite likely that experiencing chest pain and other symptoms after eating can increase our stress level. According to a study from 2018:
This cross-sectional study revealed that anxiety and depression levels were significantly higher in subjects with GERD (notably in the NERD) than in controls.(source)
- GERD: gastroesophageal reflux disease, the chronic form of acid reflux (2 or more episodes per week)
- NERD: non-erosive reflux disease, same as GERD, but the esophagus is not damaged
Looks like stress can cause reflux, which might cause more stress and so on…
How to relieve stress triggered by acid reflux?
Acid reflux is usually managed by antacids and proton-pump inhibitors (PPIs). These medications neutralize stomach acid so that it won’t irritate the esophagus. Problem solved. Or not?
Depending on your condition, such medications might be required, let your doctor decide that. However, there is a lot you can do the help your body manage the symptoms.
If certain foods cause acid reflux, try to avoid those foods. If stress causes acid reflux, try to alleviate stress. Easier said than done, a few tips might help:
- physical activity
Stress is a part of our lives. Sometimes a small amount of stress is beneficial, however, long-term chronic stress takes its toll on our bodies.