GERD Symptoms During Exercise: A Comprehensive Guide

Gastroesophageal reflux, chest tightness, exercise?

Hello, Doctor.
I would like to seek your advice.
I have noticed that during activities such as walking, brisk walking, running, climbing stairs (about three floors), right after taking a shower, or suddenly standing up after squatting, I frequently experience symptoms similar to gastroesophageal reflux disease (GERD).
Specifically, I feel food particles rising from my esophagus, experience belching, and have a sensation of tightness in my chest and throat.
Besides these situations, I also experience similar symptoms after eating or when I am fasting, which is quite distressing for me.
Additionally, my physical activity and stamina have decreased; I often feel fatigued and dizzy.
These symptoms have persisted for over a year.
The main concern is that they make me hesitant to exercise, and I worry whether this could indicate cardiovascular disease.

I consulted a gastroenterologist who mentioned that GERD typically occurs when lying down rather than during exercise.
However, I find that my symptoms are more pronounced during physical activities, such as exercising or climbing stairs.
Consequently, I visited two medium-sized hospitals' cardiology departments, where doctors listened to my heart, performed resting electrocardiograms, echocardiograms, blood tests, and X-rays.
The results indicated that both doctors found no structural issues with my heart, only a minor, almost negligible mitral valve prolapse.
Their diagnosis was autonomic nervous system dysfunction; I do not have hypertension or diabetes, and my cholesterol levels are normal, although my triglycerides are slightly above the standard at around 160.
I do not smoke or drink alcohol, so they suggested that I should exercise more to better adapt to these situations.

However, after reading some medical literature, I am still uncertain whether these tests can definitively rule out cardiovascular disease, especially since I have not undergone an exercise stress test.
Lacking medical training, I only know that I still feel uncomfortable in many of these daily activities, and I have not received an explanation for my symptoms, which leaves me quite anxious.
I also consulted a psychiatrist who prescribed a medication for palpitations, but I still do not understand why this is happening.
Sometimes, even a short walk makes me feel unable to continue, and I hesitate to go far from home, which significantly limits my daily life and increases my anxiety.
Therefore, I would like to ask you how you would recommend I adjust to this situation, which specialty I should consult, or how I should integrate the results from these various specialties.
I truly feel lost in the medical process.
Additionally, I would like to know your opinion on what these symptoms might indicate.
Why do I experience these seemingly GERD-like symptoms specifically during exercise? Thank you!

R, 20~29 year old female. Ask Date: 2023/03/05

Dr. Liao Yaopan reply Family Medicine

Hello, based on the description above, if it is gastroesophageal reflux disease (GERD), it is advisable to seek proper treatment.
You may first consult your family physician for evaluation, maintain a regular routine, ensure a balanced diet, and avoid excessive psychological stress.
Online consultations are not equivalent to in-person medical visits and cannot provide diagnoses or treatment recommendations.
Changhua Hospital cares about you.

Reply Date: 2023/03/05

More Info

Understanding GERD (Gastroesophageal Reflux Disease) symptoms during exercise can be quite complex, especially when combined with other factors such as anxiety and physical fitness levels. Your experience of symptoms like food regurgitation, burping, and chest tightness during activities such as walking, stair climbing, or even after bathing is indeed concerning and warrants a thorough understanding.

Firstly, it’s important to recognize that GERD can manifest in various ways, and physical activity can exacerbate these symptoms. When you exercise, especially activities that involve bending or heavy exertion, the increased intra-abdominal pressure can push stomach contents back into the esophagus, leading to the symptoms you described. This is particularly true if you have a full stomach or if your body is in a position that promotes reflux.

Your symptoms occurring during exercise, as well as after eating or even when you are fasting, suggest that there may be a combination of factors at play. The fact that you have been experiencing these symptoms for over a year indicates that it might be beneficial to explore this further. While your gastroenterologist mentioned that GERD typically occurs when lying down, it is not uncommon for individuals to experience reflux symptoms during physical activity, especially if they have underlying conditions such as a hiatal hernia or esophageal motility disorders.

The tests you have undergone, including echocardiograms and stress tests, have ruled out significant cardiovascular issues, which is reassuring. The slight mitral valve prolapse noted is often benign and not typically associated with the symptoms you are experiencing. The diagnosis of autonomic nervous system dysregulation may also play a role, as this can affect how your body responds to stress and physical exertion.

Given your symptoms and the impact they have on your daily life, here are some recommendations:
1. Dietary Modifications: Consider keeping a food diary to identify any specific triggers that may exacerbate your symptoms. Common culprits include spicy foods, caffeine, chocolate, and large meals. Eating smaller, more frequent meals may help reduce the pressure on your stomach.

2. Exercise Adjustments: While exercise is important for overall health, you may need to modify your routine. Low-impact activities such as walking, swimming, or cycling may be better tolerated. Avoid exercises that require bending over or lying flat immediately after eating.

3. Posture During Activities: Pay attention to your posture during exercise. Keeping an upright position can help minimize reflux symptoms. If you feel symptoms coming on, try to slow down or take a break.

4. Consultation with Specialists: Since you have seen both gastroenterology and cardiology, consider consulting with a specialist in sports medicine or a gastroenterologist who specializes in functional gastrointestinal disorders. They may provide insights into how to manage your symptoms during physical activity.

5. Mental Health Support: Anxiety can exacerbate physical symptoms, so it may be beneficial to continue working with a mental health professional. Techniques such as cognitive-behavioral therapy (CBT) or mindfulness may help you manage anxiety related to your symptoms.

6. Further Testing: If symptoms persist, you might want to discuss the possibility of additional tests, such as a 24-hour pH monitoring study or esophageal manometry, to assess how well your esophagus is functioning and to confirm the presence of reflux.

In summary, while your symptoms may resemble GERD, the interplay of physical activity, dietary habits, and anxiety could be contributing to your discomfort. By making some lifestyle adjustments and seeking further evaluation from the appropriate specialists, you can work towards managing your symptoms more effectively. Remember, it’s essential to listen to your body and take gradual steps towards increasing your physical activity while addressing your symptoms.

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