STRESS AND GASTROESOPHAGEAL REFLUX DISEASE

Dalbir S  Sandhu; Ronnie  Fass

doi:10.25040/ntsh2018.02.010

Dalbir S Sandhu Division of Gastroenterology and Hepatology, Department of Medicine MetroHealth Medical Center and Case Western Reserve University Cleveland, Ohio, USA
Ronnie Fass Division of Gastroenterology and Hepatology, Department of Medicine MetroHealth Medical Center and Case Western Reserve University Cleveland, Ohio, USA

DOI: https://doi.org/10.25040/ntsh2018.02.010

Keywords: Stress, gastroesophageal reflux disease, esophageal hypersensitivity

Abstract

Gastroesophageal reflux disease (GERD) is one of the commonest conditions managed by clinicians. Regurgitation and heartburn are considered the cardinal symptoms of GERD. In recent decades, an increasing association has been noted between stress and GERD and our knowledge about the pathophysiology of this relationship is constantly evolving. Both acute and chronic stress can accentuate GERD related symptoms. Subjects exposed to chronic life stressors are more likely to complaint of GERD symptoms. Current data suggests that acute stress exacerbates GERD symptoms by enhancing the perceptual responses to intra-esophageal acid stimulivia central mechanisms without increasing the amount of acid reflux. This process is likely mediated by an increase in esophageal mucosal permeability. Treatment with proton pump inhibitors attenuates the effect of acute stress on esophageal perception thresholds for pain. However, the effect of anti-reflux therapy in patients experiencing chronic stress remains to be elucidated.

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