Can Post-Traumatic Stress Disorder (PTSD) cause Gastroesophageal Reflux Disease (GERD)?

From the Guidelines

Yes, Post-Traumatic Stress Disorder (PTSD) can contribute to the development or worsening of Gastroesophageal Reflux Disease (GERD). The connection between these conditions involves the body's stress response system, as noted in the context of symptom generation in GERD, where anxiety or stress-induced symptoms suggest visceral hypersensitivity and/or hypervigilance 1. When someone experiences PTSD, their body often remains in a heightened state of stress, with increased production of stress hormones like cortisol and adrenaline. This chronic stress can affect digestive function by altering stomach acid production, delaying stomach emptying, and causing dysfunction in the lower esophageal sphincter (the muscle that prevents stomach acid from flowing back into the esophagus).

Key factors to consider in the management of GERD in patients with PTSD include:

• Symptom characterization to discern the likelihood of pathologic GERD and the mechanisms driving symptoms 1
• The potential for central obesity and/or a known hiatal hernia, which could point to a mechanical etiology of gastro-esophageal reflux
• The impact of anxiety or stress-induced symptoms, suggesting visceral hypersensitivity and/or hypervigilance
• Behavioral disorders, including rumination and supragastric belching, which can contribute to symptom generation

Treatment approaches should address both conditions simultaneously, including PTSD therapies like cognitive behavioral therapy or EMDR, along with GERD management through medications such as proton pump inhibitors (like omeprazole 20-40mg daily) or H2 blockers (like famotidine 20mg twice daily), dietary modifications, and stress reduction techniques. Patients should avoid trigger foods (spicy, fatty, acidic), eat smaller meals, avoid lying down after eating, elevate the head of their bed, and practice relaxation techniques to help manage both conditions effectively.

From the Research

PTSD and GERD Relationship

• The relationship between Post-Traumatic Stress Disorder (PTSD) and Gastroesophageal Reflux Disease (GERD) has been investigated in several studies 2, 3, 4.
• Research suggests that PTSD can contribute to the development of GERD symptoms, with one study finding that early post-9/11 asthma and PTSD were each independently associated with both the persistence of GERD symptoms and the development of new GERD symptoms 2.
• Another study found that persistent GERD symptoms occurred more often among individuals with comorbid PTSD, with 24% of those with PTSD experiencing persistent GERD symptoms compared to 8% of those without PTSD or asthma 3.

Mechanisms and Risk Factors

• The exact mechanisms by which PTSD contributes to GERD are not fully understood, but it is thought that stress and anxiety associated with PTSD may exacerbate GERD symptoms 5.
• Lifestyle and dietary factors, such as excessive body weight, moderate to high alcohol consumption, smoking, and certain foods, may also contribute to the development of GERD symptoms 6.
• Disaster-related environmental exposures, such as those experienced by individuals exposed to the 9/11 terrorist attacks, may also play a role in the development of GERD symptoms 3.

Clinical Implications

• Clinicians should be aware of the potential relationship between PTSD and GERD, and consider assessing patients with GERD symptoms for comorbid PTSD and other mental health conditions 2, 4.
• Treatment of GERD should take into account the patient's mental health history and cognitive functioning, and may involve a multidisciplinary approach that includes psychological support and lifestyle modifications 4.