Article: Gastro-oesophageal Reflux Disease and Psychological Comorbidity

I. Mizyed; S.S. Fass; R. Fass


Aliment Pharmacol Ther. 2009;29(4):351-358. 

In This Article

Stress and GERD

Various studies evaluated the effect of stress on the gastrointestinal tract. More recent studies have focused on the relationship between stress and reported symptoms of GERD.[22] However, when evaluating these studies, one should consider the stressors used, if the stress is acute or chronic, if the complaints are subjective or objective and, most importantly, the subjects being evaluated. There are a variety of stressors that have been used in these studies, including white noise, exposure to cold temperature, loud noises and anticipation of stressful situations such as giving a speech. Overall, these stressors result in acute stressful situations. Other studies screened for subjects who experience a prolonged stressful situation such as being primary caregiver to a terminal loved one.

It has been shown that subjects who have been exposed to prolonged life stressors are more likely to complain of symptoms of GERD. One study demonstrated a correlation between discussion of emotionally charged topics and nonpropulsive activity in the oesophagus.[23] Another study assessed gastric acid output in relation to personality traits. It was found that subjects who were considered to have a higher level of impulsivity and expressed emotions more freely were more likely to react with an increase in gastric acid output when subjected to stress simulated by a problem-solving session than patients with low level of impulsivity.[24] In fact, subjects with low level of impulsivity reacted to this stress with a decrease in gastric acid secretion. Increased gastric acid secretion has been seen in subjects with a higher tendency towards emotional lability. Bradley et al.[22] evaluated the relationship among stress, psychological traits associated with chronic anxiety, acid reflux parameters and perceptions of reflux symptoms. These researchers found that stress tasks did not influence objective measurements of acid reflux (total acid exposure, number of acid reflux events and duration of longest acid reflux event). Another significant finding was that reflux patients who were chronically anxious and exposed to prolonged stressful stimuli may be more likely to perceive low-intensity oesophageal stimuli as painful reflux symptoms. Therefore, even normal oesophageal acid exposure could trigger complaints of GERD symptoms. Also, it is not a specific psychiatric disorder that may be responsible for gastrointestinal distress but the presence of psychological distress that predisposed a patient to have clinical manifestations of GERD.[19]

A recent study by Naliboff et al.[25] found that 'vital exhaustion', which is a measure of sustained stress symptoms, was most closely correlated with symptoms of heartburn. Fass et al.[26] have shown that acute auditory stress can exacerbate heartburn symptoms in GERD patients by enhancing perceptive response to intra-oesophageal acid exposure. This greater perceptual response is associated with greater emotional responses to the stressor.


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