You don’t have to be intimately familiar with the science to see that there could be a link. After all, both acid reflux and anxiety, separately, are incredibly common in the United States. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK for short) estimates that about 20% of people in the United States suffer from long-term acid reflux. <1> And the Anxiety and Depression Association of America, or ADAA, reports that “anxiety disorders are the most common mental illness in the U.S.” with about 18% of the adult (18+) population affected. Thus, it’s likely that there is some overlap in those with anxiety and those with acid reflux. <2>
But can anxiety cause acid reflux, or do they just happen to be comorbid (co-occurring) conditions? That’s what we aim to find out. In this article, we’ll cover what acid reflux is, its causes, and the potential links to anxiety.
What is Acid Reflux?
Acid reflux is a common term that describes the contents of your stomach sliding into your esophagus. (This is the “tube” that runs from your mouth to your stomach). People often describe this as a painful, burning sensation in their chest or throat. Symptoms can range from mildly uncomfortable to “I’m going to the ER now,” depending on the cause. <1>
In medical circles, acid reflux is more formally known as “GER,” or gastroesophageal reflux. You may also hear this condition referred to as:
- Acid indigestion
- Acid regurgitation
GERD, or gastroesophageal reflux disease, is a more problematic form of GER. In GERD, the symptoms of acid reflux are more severe or more frequent and last longer. This form of acid reflux may cause other health concerns in the long-term, such as esophageal stricture, asthma, or a chronic cough. <1>
Symptoms of GERD
With any disease or disorder, it’s important to know the most common symptoms. Aside from heartburn in the chest and throat, GERD may also present with: <3>
- Bad breath (especially in long-term sufferers)
- Upset stomach
- Pain in swallowing
- More intense symptoms when lying down
Causes of Acid Reflux
- Consuming fatty or acidic foods
- Eating before bed
- Smoking cigarettes or drinking alcohol
You’ll notice that we left one glaring omission on our list – the whole purpose of this article, in fact: anxiety.
So, Can Anxiety Cause Acid Reflux?
In short, yes, anxiety can cause acid reflux – although the direct cause-and-effect relationship isn’t always straightforward. There have been several studies, including one cited below, that show that individuals with acid reflux are more likely to have a mental disorder or concern such as: <4> <5>
- Sleeping issues
To get a better understanding of the relationship between anxiety and GERD, and to thoroughly answer the question “Can anxiety cause acid reflux?”, we’re going to once again consult science.
This cross-sectional study published in the peer-reviewed medical journal Cureus focused on the occurrence of anxiety and depression in patients who presented with GERD, either with or without chest pain. A total of 258 patients with GERD participated; of those, just under half complained of chest pain. After a psychiatric review assessing each patient’s anxious or depressive states, the study found that:
- 107 patients (41.4%) were depressed
- 89 patients (34.4%) had anxiety
- 70 patients (27.1%) had comorbid depression and anxiety
Overall, this study found that anxiety and depression both occurred more frequently in patients with GERD. Additionally, those who presented with chest pain were even more likely than those without to have one or both mental disorders.
This study examined the relationship between GERD and psychopathology – particularly mood and anxiety disorders – in a randomly selected sample of 1,084 adult women. Participants were chosen from a pool of patients in the Geelong Osteoporosis Study. Through a variety of clinical and psychiatric assessments, this study concluded that:
- Current anxiety disorders were associated with increased odds of GERD symptoms
- Lifetime mood disorders increased lifetime GERD symptoms 1.6-fold
- Lifetime anxiety disorders increased lifetime GERD symptoms 4-fold in obese participants (the same was nottrue for obese participants)
While this study focused primarily on women, it’s important to note that women are more likely to suffer from anxiety than men. As such, they make up a larger population of those with anxiety, as well as those with comorbid anxiety and GERD.
How Can Anxiety Cause Acid Reflux?
Thus far, we’ve shown that individuals with acid are more likely to have anxiety, too. But how can anxiety cause acid reflex?
To that end, the science isn’t entirely clear. What we do know is that multiple studies, including those above, have shown that higher levels of stress can lead to or increase symptoms of GERD. This includes acid reflux. At the same time, stress can also lead to higher levels of anxiety. This can lead to more stress, which may make heartburn worse. <3> <4> <5>
Additionally, some studies suggest that anxiety may have an impact on your perception of pain. The more anxious you are, the more you feel painful stimuli – including the burning sensation caused by acid reflux. While this isn’t a cause-and-effect, it may be why some individuals with anxiety report worse GERD symptoms. However, further research on the topic is needed. <3> <7>
Furthermore, there is some limited evidence that anxiety and other mental disorders may affect your digestive process. This includes the lower esophageal sphincter – a band of muscle just above your stomach. Your esophageal sphincter is responsible for the opening to let food into your stomach and closing to keep acid from coming out. When this fails, acid reflux can occur. Thus, if there is a link between anxiety and a weak esophageal sphincter, this may be the missing cause-and-effect. However, once again, more research is needed before scientists fully understand the link. <7>