Gastroesophageal reflux disease is a common condition among many people. It is common for acid reflux from the stomach to the esophagus sometimes, but if it occurs at least once a week, it becomes a symptom of GERD. The severity of its symptoms may vary according to each disease and its recurrence rates.

What is GERD

GERD, or gastroesophageal reflux, is a condition in which stomach acid repeatedly flows into the esophagus. This is due to a defect in the lower esophageal sphincter. This causes mild acid reflux at least twice a week, or it can be moderate or severe.

This may result in inflammation and irritation in the lining of the stomach and esophagus. One of its most common symptoms is belching and heartburn, which causes pain and burning in the middle of the chest, and sometimes in the throat as well. But you should know that heartburn may also occur in the case of hydrochloric acid deficiency.

On the other hand, some people may not experience the classic symptoms of GERD such as heartburn. Which may make it more difficult to diagnose, so this condition is known as Silent GERD.

Both GERD and stress or psychological tension may be closely linked, which may worsen the symptoms of stomach acid reflux, so people who may suffer from worrisome symptoms that do not respond to home remedies should consult a doctor.

Causes of GERD

Certain factors may increase the risk of developing GERD, such as:

• Obesity
• pregnancy
• Hiatal hernia
• Slow stomach emptying rate
• Eating fatty foods that cause heartburn or GERD
• Eat meals, which may be large or contain fat, just before bed
• Eat spicy foods
• smoking
• Alcohols
• Anxiety, stress and depression
• Low levels of magnesium in the body, which may cause poor functioning of the sphincter muscle
• Excessive exercise causing stomach acid to reflux by increasing pressure on the abdominal cavity

The researchers also found a strong relationship between GERD symptoms and irritable bowel syndrome. The incidence of GERD in people with Irritable Bowel Syndrome increases 4 times higher than in people who do not suffer from it.

Medication side effects

This, in addition to taking some types of medications and nutritional supplements, can cause irritation in the lining of the stomach. Among the types of these drugs:

• antibiotics such as tetracycline and clindamycin
• Pain relievers such as ibuprofen and aspirin
• Iron supplements
• potassium supplements
• anticholinergics such as oxybutynin
• Tranquilizers such as diazepam and temazepam
• Calcium channel blockers, which lower blood pressure
• Cyclic (tricyclic) antidepressants such as doxepin

The relationship between GERD and stress

Some researchers believe that there is a relationship between GERD and stress. And this is after a study in 2015 concluded that high rates of stress and anxiety significantly affect the increased risk of GERD and the emergence of associated symptoms such as heartburn and upper abdominal pain.

When anxiety and stress levels increase, the movement of the esophagus and the sphincter muscle, which relaxes in order to allow liquids and food to enter the stomach, and then closes again to prevent the flow of stomach contents again, may be affected. This prompted some researchers to recommend combining psychological and medical methods in the evaluation of gastroesophageal reflux.

Some researchers also found in 2019 that people with GERD and chest pain had much higher rates of anxiety and stress, compared to those who did not suffer from chest pain.

Although many researchers believe that there is a link between stomach acid reflux and anxiety, there is still no scientific evidence that directly links anxiety to GERD.

Symptoms of esophageal reflux

Knowing the symptoms of gastroesophageal reflux and psychological tension may help to distinguish between them, knowing that the symptoms of GERD may differ from one person to another, but it is considered one of the most prominent symptoms of reflux in the occurrence of heartburn, which may be felt more when a person bends, lies down, or when eat the food. Among the most common symptoms of GERD are:

• Nausea
• vomiting
• pain in chest
• difficulty swallowing
• Burning sensation in the throat
• Dry mouth
• Bad breath
• sleep disturbance
• Cough
• bitter taste in the mouth
• Gum irritation
• bloating
• Gases
• burping

But if you suffer from GERD while sleeping, you may also suffer from the following symptoms:

• sleep disturbances
• asthma
• Chronic cough
• Feeling of suffocation
• difficulty swallowing

In a number of studies, researchers have also found a strong relationship between GERD and allergic rhinitis. Many of the participating patients were diagnosed with both GERD and allergic rhinitis.

Psychological symptoms of GERD

Like the symptoms of GERD, symptoms of anxiety and stress may vary from person to person. Among the most important of these symptoms:

• Physical and mental stress
• rapid breathing
• fast heart rate
• Insomnia and difficulty sleeping
• Nervousness and extreme excitement
• Difficulty concentrating
• The appearance of other digestive problems such as gas, constipation, and diarrhea
• Panic attacks when symptoms become more severe

Note that episodes of severe malaise (panic attacks) may occur when severe symptoms begin to appear very quickly. Symptoms of these seizures may include increased heart rate, a sense of extreme fear, and difficulty in breathing.

Complications of GERD symptoms

Neglecting the symptoms of GERD and not receiving timely treatment may lead to health complications. Complications of GERD are:

• Esophagitis: If left untreated, this may lead to damage or scarring of esophageal cells, causing pain and difficulty swallowing.
• Barrett’s esophagus: Untreated GERD may damage the pink lining of the swallowing tube, causing the lining to thicken and turn red. Cancer can also be a complication of this condition.
• Respiratory problems: Such as hoarseness, asthma, and pneumonia

Treating GERD and stress

Some people may suffer from GERD symptoms and psychological tension from time to time, but when reflux symptoms and psychological tension occur on a regular basis, it is necessary to work on treating them or preventing their occurrence so that the symptoms do not worsen.

In addition, there are some steps that can be tried at home before the doctor recommends medical treatment, such as:

• Follow a healthy diet.
• Avoid foods that may cause heartburn or GERD, such as black pepper, garlic, citrus fruits such as lemon and orange, and tomatoes.
• Avoid fatty or greasy meals.
• Avoid overeating, and it is preferable to eat 5 small meals a day instead of eating several large meals.
• Avoid eating meals 2 to 3 hours before bedtime.
• Exercising regularly.
• Relaxing, relieving stress and avoiding anxiety factors.
• Avoid caffeine such as coffee, tea, and soda.
• Get enough sleep.
• Take over-the-counter antacids, such as calcium carbonate, which are used to reduce stomach acidity.
• Taking proton pump inhibitors (medicines that help reduce gastric acid production by inhibiting the action of an enzyme in the stomach wall responsible for acid production).

Treating symptoms of anxiety and stress

In order to reduce the symptoms of anxiety and psychological stress, doctors may also recommend taking some steps to reduce the intensity of stress, including the following:

• Reducing caffeine intake
• Attending cognitive behavioral therapy sessions
• Follow some practices that help relieve anxiety, such as meditation and yoga
• Take some prescribed medications such as antidepressants (selective serotonin reuptake inhibitors) and benzodiazepines.
• Avoid drugs and alcohol

Notice: You must follow the doctor’s instructions when using any of the medications prescribed to treat anxiety and sleep disorders, given that some types of medications may have severe negative effects.

When should you visit the doctor?

• Suffering from severe and frequent GERD symptoms.
• Suffering from chest pain, especially if symptoms of shortness of breath and pain in the jaw or arm appear, this may be a symptom of a heart attack.
• If you take over-the-counter heartburn medicines more than twice a week.

Frequently asked questions about esophageal reflux