Beyond Heartburn: Why Your Acid Reflux Won’t Go Away

Acid reflux is often brushed off as a reaction to spicy food or a heavy meal, but for many people, it can become a chronic condition that affects daily life. This can occur as gastroesophageal reflux disease (GERD), erosive or non-erosive, and laryngopharyngeal reflux disease (LPR). Each of these conditions presents itself differently and has distinctively different impacts on women, meaning it is important to consider treatments holistically and to one’s whole body rather than solely a digestive system complication. 

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This condition is prevalent among 20% of adults and 10% of children in the United States, and can significantly impact daily life [1]. However, different types of GERD affect women differently, meaning it is crucial to recognize the different symptoms, causes, and distinctions from other digestive conditions. Recognizing when acid reflux has progressed to a chronic state can help individuals know when to consult a professional and how to manage their symptoms effectively.

Gastroesophageal reflux disease (GERD) is the chronic (at least twice a week for several weeks) upward flow of acid from the stomach up to the esophagus. Symptoms include backwash of stomach acid into the throat, a burning feeling in the chest or stomach, non-cardiac chest pain, nausea, and/or sore throat [1]. It is important to note the difference between gastritis located in the stomach, occasional acid reflux that may occur after some meals, and GERD, where treatments are long-term changes to the diet and lifestyle. GERD is also the overarching condition that is classified into more specific diseases, erosive and non-erosive reflux disease.

Erosive reflux disease (ERD) is when the symptoms described above show up as inflammation, irritation, and swelling of the esophageal lining. This damage is specifically known as esophagitis. Reflux can also show up without the same esophageal damage seen in ERD. This is called non-erosive reflux disease (NERD), where the same symptoms are experienced without any esophageal mucosal injury visible through an upper endoscopy [2]. While this type of damage is absent, the symptoms are still severe and can negatively impact someone’s quality of life. 

Laryngopharyngeal reflux disease (LPR) is another type of acid reflux where the acid travels up to the throat and voice box. Symptoms include feeling a lump in the throat without any obstruction present, throat clearing, postnasal drip, and excess throat mucus [3]. These symptoms are often misdiagnosed because allergies and postnasal drip can occur without any reflux. For this reason, it’s important to be mindful of how your diet impacts your symptoms and to be aware of what may cause inflammation and what may not. LPR can occur along with GERD, but it can also be experienced independently. It is noteworthy that symptoms may not be as noticeable in elderly patients due to neurological deterioration of these nerve endings, and women also experience symptoms more severely compared to men [4]. 

How does acid reflux show up differently in women?

When comparing these diagnoses with relation to sex, NERD is seen more in women whereas ERD is seen more commonly in men. This is because the estrogen in women acts as a protective factor against tissue damage in the esophagus, which also explains why acid reflux is seen more postmenopause as estrogen levels drop. Once the  protective estrogen layer is suddenly removed, there may be increased symptom severity for those suffering from chronic acid reflux [2]. However, studies show that elevated estrogen may also be linked to increasing acid reflux by relaxing the lower esophageal sphincter (LES). The LES prevents the backflow of acid back into the esophagus and only allows food to travel down, but weakening and relaxation of the LES does not allow it to perform its job. This could explain why women are more likely to experience symptomatic reflux as a whole compared to men [2]. 

Although women experience symptoms more intensely, they respond to medical treatments involving protein pump inhibitors (PPIs) less than men do. PPIs are commonly in prescribed and over the counter medications such as omeprazole, esomeprazole, lansoprazole, pantoprazole, and dexlansoprazole. Their function is to block the enzymes in the stomach from releasing stomach acid, providing space for the esophagus to heal. But why don’t they work for all women? In many cases, it’s seen that women have a weaker acid in the pH scale, which PPIs do not target [2]. The reflux may contain bile and/or other non-acid components as well. 

The Role of Mental Health

Mental health plays an indirect role in digestion through  involvement of  the hypothalamic-pituitary-adrenal (HPA) axis, the nervous system, and neurotransmitters. The HPA axis is how your body reacts to stress and as a result, controls processes such as digestion. Chronic stress, depression, and anxiety negatively impacts digestion and relaxes the LES, causing acid to flow back up. NERD, specifically, is associated more with depression and anxiety [5]. This means women dealing with mental health concerns on top of hormonal changes are likely to experience related changes in acid reflux symptoms. 

The association between reflux and mental health is cyclic in nature because of the discomfort that chronic reflux brings. GERD leads to sleepless nights and days where you feel like this is never ending. These feelings accumulate into psychological distress, where these two factors reinforce each other. Being cognizant of this may help women better manage their symptoms and get back to pain-free daily life.

What Can You Do?

Treating GERD or LPR requires an approach that looks at the entire picture, which includes the type of reflux, primary contents of the reflux, hormonal changes, and mental health. If certain medications don’t improve your symptoms, it may be that it’s not specific for the reflux contents like a weaker acid or bile. Many treatments also begin with changes to your diet and understanding what foods would be a trigger for you. This means keeping a detailed food diary. Although diet is a crucial component of reflux, mental health can be just as important and central to this condition. This means that taking care of your psychological well-being, by seeing a mental health professional or talking to someone close to you, is important to avoid symptoms from relapsing. It is best to consult your doctor with this knowledge in mind so they can provide you with the treatment plan best suited for you. 

References

1. Cleveland Clinic [Internet]. [cited 2026 Jul 3]. Acid Reflux & GERD: What To Know. Available from: https://my.clevelandclinic.org/health/diseases/17019-acid-reflux-gerd

2. Scheese D, Chehab M, Puig CA. Sex Differences in Gastroesophageal Reflux Disease (GERD). Foregut. 2023 Jun 1;3(2):192–8. doi:10.1177/26345161231166136

3. Lechien JR, Akst LM, Hamdan AL, Schindler A, Karkos PD, Barillari MR, et al. Evaluation and Management of Laryngopharyngeal Reflux Disease: State of the Art Review. Otolaryngol Head Neck Surg. 2019 May;160(5):762–82. doi:10.1177/0194599819827488 PubMed PMID: 30744489.

4. Lechien JR, Carroll TL, Bobin F, Muls V, Rodriguez A, Horoi M, et al. Influence of Age and Sex on Clinical and Therapeutic Features of Laryngopharyngeal Reflux. Otolaryngol Head Neck Surg. 2022 Mar;166(3):468–76. doi:10.1177/01945998211020284 PubMed PMID: 34154447.

5. Choi JM, Yang JI, Kang SJ, Han YM, Lee J, Lee C, et al. Association Between Anxiety and Depression and Gastroesophageal Reflux Disease: Results From a Large Cross-sectional Study. J Neurogastroenterol Motil. 2018 Oct;24(4):593–602. doi:10.5056/jnm18069 PubMed PMID: 30347938; PubMed Central PMCID: PMC6175551