Gastroesophageal Reflux Disease (GERD) is a disorder where stomach and duodenal contents reflux into the esophagus, resulting in symptoms including acid reflux and heartburn.1 Reflux can also induce tissue damage in the mouth, throat, airway, and other tissues surrounding the esophageal collar, resulting in extra-esophageal symptoms such as pharyngitis, idiopathic pulmonary fibrosis, cough, hoarseness, asthma and so on.2 GERD is among the most prevalent chronic disorders worldwide. It is growing more widespread, particularly in developing countries. GERD poses a significant burden on individuals and their families, negatively impacting their quality of life, physical and emotional health. Nowadays, GERD is considered as a serious health condition across the world.3-4   Numerous studies have explored the link between psychological variables and GI problems .5-6 Stress can impact the gastrointestinal tract, causing symptoms and disorders. Psychological variables impact functional gastrointestinal illnesses, such as gastroesophageal reflux disease, via the gut-brain axis.

 Several research on GERD have found that psychological issues, particularly melancholy and anxiety, might cause gastrointestinal difficulties or symptoms. Whenever anxiety or depression develops, treatment of functional disorders becomes more challenging and results in negative effects.7  Several studies have found that depression can affect reflux patients, however the results are inconsistent. Some research have examined the impact of psychosocial variables on various forms of GERD.8-9   Emotional stress can impact the gastrointestinal tract, causing symptoms and illness. Research suggests that psychological variables might impact the severity of gastrointestinal illnesses by modifying pain perception through the gut-brain axis, potentially contributing to GERD. Anxiety and stress can overstimulate the gut-brain axis, aggravating GERD symptoms and fueling concerns about gut health, creating a self-perpetuating cycle.10-11 The effect of psychological stresses on GERD has been investigated in the literature. In a cross-sectional study of 2,500 Karachi residents aged 18-40, individuals with GERD had significantly higher rates of depression and anxiety compared to those without .12 A cross-sectional study in India found a higher frequency of anxiety and sadness among patients with GERD, including both young and old populations.13

More study is needed to fully understand the link between GERD and psychological issues, as these studies have shown inconsistent results. Anxiety and despair in young adults can aggravate GERD, making it crucial to address this issue. The aim of this study was to find out the association between GERD and anxiety/depression, as well as other variables that may contribute to its higher incidence in adults.`

The present cross-sectional study was carried out at the medicine and gastroenterology department, Bolan Medical Collage Quetta from January 2025 to June 2025 after taking permission from the ethical committee of the institute. Non-probability consecutive sampling technique was used for data collection. the sample size was determined by using WHO calculator by taking 95% of a confidence interval (CI) and 16% anticipated prevalence of GERD in the young adults.12 A total of 230 individuals of both genders and different ages groups(14-41) visited OPD with GIT illnesses were included in this study. Individuals with chronic comorbidities like diabetes, ischemic heart disease, hypertension, asthma, or chronic obstructive pulmonary disease (COPD) esophageal or gastric cancer, previous gastrointestinal surgery, or peptic ulcer disease, and those with psychiatric illnesses or taking psychiatric medications, are excluded from the study. The frequency scale for the symptoms of GERD (FSSG) questionnaire was used to assess gastrointestinal diseases for GERD, with individuals scoring more than eight on the scale being categorized as having GERD 14. Anxiety was classified as having a GAD-7 score of 10 or above. 15 Depression was assessed using the PHQ-9 scale as follows: a score equal to five or above indicated that the patient was suffering from depression .16 Individuals with GERD were shown to have higher rates of anxiety and depression than the general population. The physician interviewed the participants and filled out the questionnaires. The researcher personally completed all data collection and study processes to ensure consistency and quality. Data were analyzed with SPSS version 20. Participants were grouped based on the presence or absence of GERD, anxiety, and depression using the aforementioned cutoffs. Categorical variables, such as gender, education, socioeconomic level, and smoking status were presented in frequencies and percentages. Quantitative variables were presented as means and standard deviations. Confusing features like sex, age, BMI, socioeconomic level, smoking and education levels were stratified. A chi-square test was used to examine the association between anxiety and depression and GERD. Univariate logistic regression was used to assess the effect estimates of the connection, which are provided as an odds ratio (OR) and a 95% confidence interval (CI). An ad hoc correlational analysis was conducted to investigate the relationship between FSSG scores & anxiety/depression severity as measured by GAD-7 and PHQ-9 scores. A p-value < 0.05 was considered statistically significant.

A total of 230 individuals   with GIT illnesses   were enrolled in this study out of which 122 (53.0%) were male and 122 (53.0%) were female. The mean age of the study population was 29.9±6.7 years. Participants were diagnosed with GERD using the FSSG score. GERD was recorded in 146 individuals (63.5%).71 (30.9%) of the individuals had smoked, whereas 159 (69.1%) did not smoke. In terms of socioeconomic position, 182 (79.1%) individuals were from middle class   48 (20.9%) were from lower class and no individual were from high class. According to BMI 14 (6.1%) individuals were underweight, while 20 (8.7%) were overweight and most of the individuals had a normal BMI 196 (85.2%). majority of the individuals were matriculate 110 (47.8%), 93 (40.4%) were graduates or postgraduates and 27 (11.7%) participants had education up to the primary level as presented in table 1.  Gender wise distribution showed that GERD was more common   among females as compared to males (67.9% versus. 32.1%). GERD was more commonly detected among participants with normal BMI1 38 (64.2%) and similarly the frequency was slightly higher among smokers 22 (64.7%) as compared to non-smoker 122 (62.2%). GERD was most prevalent among persons educated up to the primary school level, with 23 (82.1%). GERD affected 67 (60.9%) of individuals with matriculation/intermediate education, as well as 56 (60.9%) of graduates/postgraduates. In the lower socioeconomic category, 33 (67.3%) of individuals had GERD, whereas 16 (32.7%) did not. In the medium-income socioeconomic category, 113 (62.4%) had GERD, whereas 68 (37.6%) did not. Overall, 146 (63.5%) of the 230 participants had GERD, whereas 84 (36.5%) did not. Among the 187 individuals who did not experience anxiety, 103 (55.1%) had GERD and 84 (44.9%) did not. In contrast, all 43 individuals with anxiety (100%) had GERD, and none of them were GERD-negative. The chi-square test found a significant link between anxieties with GERD (p < 0.001). This suggests that anxiety was strongly related to the presence of GERD as presented in table 3. Among the 117 people with no depression, 35 (29.9%) had GERD, whereas 82 (70.1%) did not have it. In comparison, 112 (99.1%) of the 113 patients with depression had GERD, with only one (0.9%) not having it. In all, 147 individuals (63.9%) had GERD, whereas 83 (36.1%) did not. Individuals with depression were significantly more likely to have GERD compared to individuals without depression as presented in table 4.

GERD is a disorder that occurs when stomach acid reflux creates major complications. It has a complicated pathophysiology that includes alterations in reflux exposure, epithelial resistance, and visceral sensitivity. Gastric refluxate, a toxic substance that damages the esophagus and causes symptoms, is the main factor influencing illness severity.17 Recent research shows that lifestyle changes, as well as pharmacologic treatments such as antacids, mucosal protectants, histamine2-receptor antagonists, and proton pump inhibitors (PPI), are crucial for treating GERD. Endoscopic and surgical therapies for GERD include anti-reflux surgery, magnetic sphincter augmentation, and gastric bypass.18 GERD affects 13.98% of the world's population, with the highest frequency in the Middle East, where it approaches 20% [5]. Adults over 50, smokers, and obese individuals had a higher incidence of the condition.19 Furthermore, the prevalence of GERD differed by gender, with males having a higher incidence than females. While the definition of GERD and risk factors are widely accepted, prevalence rates fluctuate due to several circumstances, including the availability of over-the-counter antacids. Patients with GERD typically experience heartburn, retrosternal burning, and regurgitation symptoms.20 Atypical symptoms may be water brash, chest pain, dysphagia, belching, nausea, and bloating. GERD has been related to several ailments, including cancer, cardiovascular problems, and psychological issues. Clinical studies show that GERD can cause anxiety and sadness, while psychological illnesses can potentially worsen acid symptoms.21 Individuals with GERD have a higher chance of acquiring depression and anxiety. The social characteristics of GERD patients indicate a bidirectional association between GI discomfort symptoms and their influence on brain-gut integration and visceral sensitivity. Research suggests a bidirectional hormonal link between the central nervous system and the gastrointestinal tract, with GI stresses leading to increased emotional and behavioral reactions. The current study examined the association between gastroesophageal reflux disease (GERD), depression, and anxiety in young adults. The results show a robust link between psychological problems and GERD. Participants with anxiety and sadness had a significantly greater frequency of GERD than those without these psychological symptoms. These findings corroborate the accumulating evidence that GERD should not be seen only as an acid reflux problem, but rather a syndrome in which gastrointestinal, psychological, and behavioral variables may interact. GERD was recorded in 146 individuals (63.57%). Our study findings are similar the study conducted by Asim et al in which the prevalence of Gastro-esophageal Reflux Disease was (63.3%)which support our study.23 The very high incidence found may be due to the research population's features as well as the therapeutic environment in which the subjects were recruited. The incidence of GERD varies greatly depending on diagnostic criteria, demographic variables, and whether it is diagnosed using symptoms, questionnaires, endoscopy, or objective reflux testing. The current clinical recommendations recommend that GERD is a complex condition combining reflux exposure, mucosal resistance, & esophageal sensitivity rather than a single pathogenic process. Our study revealed that anxiety was strongly related to the presence of GERD. This results are in line with a 2023 comprehensive review and meta-analysis by Zamani et al., which studied 36 research and concluded that anxiety symptoms were much more prevalent among patients with GERD than healthy controls.25 A variety of processes might explain the link between anxiety and GERD. Anxiety can focus attention on physical feelings and improve awareness of normally normal esophageal stimulation. Patients may experience more extreme reflux symptoms due to increased esophageal hypervigilance and visceral sensitivity. Studies of reflux hypersensitivity and non-erosive reflux illness have showed greater visceral sensitivity, along with higher anxiety and depression ratings.26 In the present study individuals with depression were significantly more likely to have GERD compared to individuals without depression. These results are similar to the study carried out by Asim et al in their study depression was the key factor of GERD.23 The current study also found variations in GERD prevalence based on gender, smoking history, BMI, socioeconomic position, and education. GERD was more common in females, smokers, and people from lower socioeconomic groups. Yet, these categorical differences should be regarded with caution until substantiated by suitable multivariable analysis. Physical activity dietary habits, healthcare-seeking behavior, sleep quality, pharmaceutical usage, overweight and occupational stress, and may all have an impact on these associations. Current GERD recommendations reflect that a variety of lifestyle and clinical variables might affect reflux symptoms & disease manifestation.24 The correlation with smoking is biologically reasonable since smoking can harm the gastro-esophageal barrier and result in reflux symptoms. However, the current study should not be construed as showing smoking as an independent cause of GERD until an adjusted analysis shows such a connection. Similarly, while the majority of individuals in this study had a normal BMI, future analyzes should include BMI as a continuous or adequately classified variable because obesity is a well-established risk factor for GERD in many countries. Limitation of the study The current study has several limitations. It was a single center study and limited sample size so the generalizability of our results may be limited. The study did not consider the influence of family history including alcohol usage on GERD symptoms or severity.

The present study concluded that different lifestyle variables effect young adults with GERD. The association between GERD and mental health disorders, especially depression and anxiety is complicated and bidirectional. Developing comprehensive ways to manage and treat GERD and related mental health concerns in the younger population requires a thorough understanding of these relationships.

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