GERD: Managing Symptoms and Anxiety in Patients - Gastroenterology and Hepatology

Gastroesophageal reflux disease (GERD)

Hello Dr.
Chen, I have a problem with gastroesophageal reflux disease (GERD), which was diagnosed last May.
When it first occurred, I thought it was a heart issue because I experienced symptoms like chest tightness, chest pain, burning sensations, shortness of breath, and palpitations.
I have undergone several cardiac evaluations, including a resting electrocardiogram, 24-hour Holter monitor, exercise stress test, chest X-ray, cardiac enzymes, and pulmonary function tests—all of which were normal.
I also had an upper endoscopy, and the doctor mentioned that I have inflammation at the gastroesophageal junction, which is typical for GERD.
Although I am on medication to manage it, I still experience chest tightness, chest pain, and palpitations, which continue to trouble me.
The doctor has suggested that I might have autonomic nervous system dysregulation, as I sometimes feel unwell when I am anxious or stressed.
When I search for information about my symptoms online, I often come across information about myocardial infarction, which makes me worry that there might be a heart issue, leading to increased anxiety and sensitivity.
Could you please advise me on whether I need to undergo any further tests? Thank you, doctor.

Han Han, 20~29 year old female. Ask Date: 2018/06/29

Dr. Chen Shidian reply Gastroenterology and Hepatology

Hello, sir.
You can discuss with a psychiatrist whether to use anxiety medication.
Changhua Hospital cares about your health.
Chen Shidian.

Reply Date: 2018/06/29

More Info

Dear Patient,
Thank you for sharing your concerns regarding your health, particularly your experience with gastroesophageal reflux disease (GERD) and the associated symptoms of anxiety. It’s understandable that the symptoms you’ve described can be distressing, especially when they mimic those of more serious conditions like heart disease. Let’s break down your situation and explore the connections between GERD, anxiety, and your symptoms.

Understanding GERD
Gastroesophageal reflux disease (GERD) occurs when stomach acid frequently flows back into the esophagus, leading to symptoms such as heartburn, chest pain, and regurgitation. The inflammation of the esophagus, as noted in your endoscopy, is a common consequence of this condition. The symptoms you experience—chest pain, heart palpitations, and shortness of breath—are indeed typical of GERD but can also be exacerbated by anxiety.

Symptoms and Anxiety
The overlap between GERD symptoms and anxiety can create a challenging cycle. Anxiety can heighten your perception of physical sensations, making you more aware of discomfort and potentially leading to increased heart rate and muscle tension. This heightened state of awareness can make you feel as though your symptoms are worsening, which can, in turn, increase your anxiety.

1. Physical Symptoms: The symptoms you describe, such as chest tightness, palpitations, and shortness of breath, can be manifestations of both GERD and anxiety. It’s important to recognize that while GERD can cause significant discomfort, anxiety can amplify these sensations, leading to a vicious cycle of worry and physical symptoms.

2. Autonomic Nervous System: You mentioned that your doctor suggested autonomic nervous system dysregulation. This is a common issue in individuals with anxiety, where the body’s stress response can lead to symptoms like increased heart rate, sweating, and gastrointestinal discomfort.

Management Strategies
1. Medication: You are already on medication for GERD, which is a good start. Proton pump inhibitors (PPIs) or H2 blockers can help reduce stomach acid and alleviate symptoms. If you find that your symptoms persist despite medication, it may be worth discussing with your doctor the possibility of adjusting your treatment plan.

2. Anxiety Management: Since anxiety seems to play a significant role in your experience, consider incorporating anxiety management techniques. Cognitive-behavioral therapy (CBT) is particularly effective for anxiety and can help you reframe your thoughts about your symptoms. Mindfulness practices, such as meditation and deep breathing exercises, can also help reduce anxiety levels.

3. Lifestyle Modifications: Dietary changes can significantly impact GERD symptoms. Avoiding trigger foods (like spicy foods, caffeine, and alcohol), eating smaller meals, and not lying down immediately after eating can help manage reflux. Additionally, regular exercise and maintaining a healthy weight can improve both GERD and anxiety symptoms.

4. Follow-Up Care: Given your ongoing symptoms, it may be beneficial to have a follow-up appointment with your gastroenterologist to reassess your GERD management. If anxiety continues to be a significant issue, seeking help from a mental health professional could provide you with additional tools to cope with your symptoms.

Conclusion
In summary, your symptoms of GERD and anxiety are interconnected, and managing one can positively influence the other. It’s essential to continue working closely with your healthcare providers to ensure that both your physical and mental health needs are addressed. If you feel that your symptoms are not improving or if new symptoms arise, do not hesitate to seek further evaluation.
Take care, and I wish you the best on your journey to better health.

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