24.OCT.2019 5 MIN READ | 5 MIN READ

Stress doesn’t just make you feel tense – it can have real physical effects on your body, including your gut. How is stress linked to acid reflux and peptic ulcers, and how can we treat them?

What is acid reflux?

Acid reflux is a disorder that occurs when there is a backflow of stomach acid into your oesophagus. The acid irritates the lining of your oesophagus, causing a painful, burning sensation in your chest.

Symptoms of acid reflux

Acid reflux symptoms
  • A painful burning sensation in your oesophagus, especially during and after eating
  • Worsening chest pain when lying down
  • Pain when swallowing
  • Sour liquid being regurgitated at the back of your throat
  • The feeling of an object stuck at the back of your throat

Can stress cause acid reflux?

Stress increases acid production, which can increase the likelihood of experiencing acid reflux symptoms. This condition can be made worse if you react to stress by taking stimulants such as caffeine-based beverages, which tend to increase the incidence of reflux symptoms.

Treatment for acid reflux

Acid reflux is a relatively easy condition to treat as medication is easily available and effective. Here are some of the treatments you may be advised to take for acid reflux:

Antacids

Antacids are over-the-counter medications that neutralise stomach acid to relieve the pain of acid irritating your oesophagus. However, while antacids help you feel more comfortable in the short term, they can’t heal the oesophagus from acid damage. It is also important to note that the over-consumption of antacids may cause adverse side effects like loose stools or kidney complications.

Acid reducers

Acid reducers decrease the amount of acid the stomach makes. This protects the oesophagus, stomach, and intestines from getting damaged. It can also help to heal damage caused by inflammation of the oesophagus. Examples of the 2 types of acid reducers are H2 blockers and proton-pump inhibitors.

H2 receptor blocker

The active ingredient in H2 receptor blockers inhibits the cells in the stomach from producing acid. In a day, they can reduce stomach acid production by up to 70%. As a result, the irritated oesophagus lining will have more time to heal. Cimetidine, famotidine, and ranitidine are all different types of H2 receptor blockers. This group of medications, however, can cause bowel complications like constipation and diarrhoea.

Proton pump inhibitor

This group of medications works similarly to H2 receptor blockers, except that they are much stronger, reducing acid production for longer periods of time. Pantoprazole, rabeprazole, lansoprazole and omeprazole are examples of proton pump inhibitors.

Endoscopy

If medications do not alleviate your symptoms, endoscopy is usually recommended to evaluate the extent and other possible causes for the symptoms. Endoscopy also enables the taking of tissue samples from the oesophagus to make sure that a severe form of gastro-oesophageal reflux disease called Barrett’s oesophagus has not developed. Barrett’s oesophagus is a condition that increases the risk of developing oesophageal cancer.

Surgery

If medications do not alleviate your symptoms, surgery may be recommended as a last resort. A fundoplication is a minimally invasive procedure commonly done to treat chronic heartburn. In this procedure, the top part of the stomach is wrapped around the base of the oesophagus to tighten the sphincter, reducing the incidence of acid reflux. Your surgeon can operate on the outside by looking through a tiny camera inserted through a few small incisions.

What is peptic ulcer disease?

Peptic ulcers occur when stomach acid erodes your digestive tract’s own protective mucus lining. This leads to painful, open sores in the lining of your stomach (gastric ulcer) and the upper part of your small intestine (duodenal ulcer).

Symptoms of peptic ulcer disease

Peptic ulcer symptoms
  • Pain in the upper abdomen
  • Heartburn
  • Dizziness
  • Feeling full quickly when eating
  • Worsening pain between meals

Rarely, more severe symptoms may occur:

  • Vomiting blood
  • Black stools
  • Unintentional weight loss

Can stress cause ulcer disease?

The role of stress as a cause of peptic ulcers remains controversial because of difficulties associated with quantifying stress in different people. However, several studies tracking ulcer occurrence in a defined population have linked certain types of stresses to the risk of developing ulcers. These stresses include depression, work-related stress, social problems and post-traumatic stress disorder.

Studies have also shown that incidence of peptic ulcer disease rise after disasters such as city bombings and earthquakes. Individuals who develop a peptic ulcer following a traumatic life event but who are psychologically stable tend to do well after stress factors are removed.

Treatment for peptic ulcers

Peptic ulcers can usually be treated in a similar way to acid reflux by using medication to neutralise or reduce acid in the stomach. However, other approaches may be necessary. Some of the additional recommended medications can include:

Antibiotics

Helicobacter pylori is a common bacteria that can cause peptic ulcers. Once your doctor has determined that you have the bacteria present in your system, they will prescribe a suitable regimen of antibiotics to kill the Helicobacter pylori bacteria.

Cytoprotective agents

This medication increases mucus production in the stomach and increases the flow of blood throughout the digestive tract. The active ingredients form a coat to protect the ulcers in the stomach from further irritation and allow them to heal.

Endoscopy

Peptic ulcers are usually diagnosed during upper gastrointestinal endoscopy. Endoscopy is useful as samples can be taken from the stomach to ensure that the ulcer is not cancerous. Bleeding from peptic ulcer disease is usually treated by endoscopy. The doctor will identify the site of bleeding in the stomach or small intestine and apply clips to stop the bleeding.

Surgery

In very severe cases of peptic ulcer disease, a hole (perforation) in the stomach wall can occur. The hole will need to be closed surgically to avoid serious complications.

Managing your stress is key

Manage stress
It is important to identify the causes of your stress and address them. Sometimes, stress can’t be avoided, especially when you have responsibilities to handle. Still, you can find ways to release the built-up tension in your mind through some of the following activities, which help you produce endorphins and reduce stress hormones in your body:

  • Physical exercise
  • Spending time with loved ones
  • Long uninterrupted sleep

If acid production is a constant source of discomfort for you, consult your doctor, who will be able to work out the best treatment plan.

 

Article reviewed by Dr Chua Tju Siang, gastroenterologist at Mount Elizabeth Hospitals

References

Peptic ulcer. Retrieved on 26/06/19 https://www.mayoclinic.org/diseases-conditions/peptic-ulcer/symptoms-causes/syc-20354223

Gastroesophageal reflux disease (GERD). Retrieved on 26/06/19 https://www.mayoclinic.org/diseases-conditions/gerd/diagnosis-treatment/drc-20361959

Understanding Ulcer Treatment. Retrieved on 26/06/19 https://www.webmd.com/digestive-disorders/understanding-ulcers-treatment#1

24.OCT.2019
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Chua Tju Siang
Gastroenterologist
Mount Elizabeth Hospital

Dr Chua Tju Siang is a gastroenterologist practising at Mount Elizabeth Novena Hospital, Singapore.