The Society of Thoracic Surgeons reports that an estimated 10 to 20 million people in the U.S. suffer from chronic acid reflux, known as gastroesophageal reflux disease (GERD). Many others have occasional reflux that typically manifests as heartburn. Although most people with acid reflux report that stress worsens their symptoms, stress itself appears unlikely to cause acid reflux. However, stress may heighten your awareness of and sensitivity to physical discomfort and tissue irritation, leading to the perception of more frequent or intense reflux symptoms. Stress also influences lifestyle choices that may contribute to heartburn.
Many studies have tried to suss out whether stress causes physical factors that lead to acid reflux. To date, researchers have found no consistent evidence that specific physical changes account for increased reflux symptoms during periods of increased stress. For example, an April 1996 study report published in the journal "Gut" stated that neither psychological nor physical stress tests resulted in significant changes in function of the esophagus. There is also no clear evidence that factors such as increased stomach production account for more frequent or intense heartburn during stressful periods. While physical changes cannot be ruled out as possible contributing factors, it appears unlikely that they are the primary cause of stress-related acid reflux.
There are complex interactions between the brain and digestive system that can be influenced by severe or ongoing stress. The author of a December 2001 review article in "Gut" explains that persistent stress can cause brain changes that alter the perception of pain, leading to hypersensitivity and a lower pain threshold. In other words, stress might cause a perception of pain that would not normally occur. This is supported by the fact that acid reflux symptoms do not necessarily correlate to high levels of acid in the esophagus -- but stress may heighten sensitivity to tiny amounts of acid in the esophagus.
A study published in April 2015 by the journal "Internal Medicine" found that among 12,653 people with GERD who also had symptoms of stomach upset, the most common lifestyle risk factor reported by participants was "feelings of continued stress." This study also showed that GERD and stomach upset symptom improvement increases when acid-blocking medication is combined with lifestyle changes -- like not overeating, cutting back on greasy and sweet foods, and avoiding smoking and drinking alcohol. During stressful times, people have a tendency to overeat and make less healthy lifestyle choices. So, in a sense, even if stress doesn't directly cause changes in the esophagus, the lifestyle choices often precipitated by stress can contribute to increased acid reflux.
Next Steps, Warnings and Precautions
Practicing relaxation techniques may help reduce symptoms of stress-related acid reflux. Talk with your doctor about your both your stress and digestive system symptoms, particularly if you experience frequent acid reflux or if your symptoms suddenly worsen. Seek immediate medical care if you experience chest pain, dizziness, fainting, shortness of breath, severe abdominal pain, frequent or persistent vomiting, or bloody or black stools. These symptoms may signal a serious medical condition.
Medical advisor: Jonathan E. Aviv, M.D., FACS