Reflux: stress, extra kilos and a sedentary lifestyle ignite the 'fire' in the oesophagus

Those who have been living with reflux for many years and, in addition, also suffer from anxiety, are much more likely to develop a chronic form that is difficult to control.

by Mari Rita Montebelli

27 May 2026

Woman touching stomach painful suffering from stomachache causes of menstruation period, gastric ulcer, appendicitis or gastrointestinal system desease. Healthcare and health insurance concept ipopba - stock.adobe.com

4' min read

Translated by AI

Versione italiana

Key points

Anxiety and stress: the real allies of reflux
New drugs and probiotics: cures 3.0
Endoscopic mini-surgery: to repair anti-reflux valve
The easiest cure? Move more

4' min read

Translated by AI

Versione italiana

Heartburn that never goes away? The culprit could be gastro-oesophageal reflux disease. Or, in more colloquial terms, 'reflux'.

It is one of the most common digestive disorders in the world, manifesting itself as an insistent and painful 'fire' that burns behind the sternum and is caused by the rise of acidic gastric juices. But the causes are not limited to 'too much acid'; poorly functioning muscles in the oesophagus, an imbalance in the intestinal microbiome and poor digestive mucosal health also play a role. Usually antacid medications and proton pump inhibitors (PPIs) manage to control it effectively, but not always. And in these cases we speak of 'refractory' reflux, i.e. treatment-resistant.

Anxiety and stress: the real allies of reflux

In order to understand the causes of reflux forms and their distinctive features, a group of Chinese researchers from the First Medical Center of Chinese PLA General Hospital in Beijing, studied patients followed at 18 hospitals in Shanghai. And at the end of this thorough reconnaissance, they came to a conclusion: those who have been living with reflux for many years and, in addition, also suffer from anxiety, are much more likely to develop a chronic form that is difficult to control. Anxiety, stress and a sedentary lifestyle may therefore play a decisive role in turning gastro-oesophageal reflux disease (GERD or MRGE) into a more stubborn and difficult-to-treat form.

The good news is that there is also an unsuspected, effective and, moreover, low-cost weapon to combat this annoying companion: movement. Moderate physical activity for at least one and a half hours per week was found to be associated with a lower risk of 'resistant' reflux in this study.

New Drugs and Probiotics: Cures 3.0

On the 'traditional' treatment front, doctors can now use traditional drugs at different dosages (antacids or PPIs), switch molecules or use more innovative treatments. These include the P-CAB (Potassium-Competitive Acid Blocker), such as tegoprazan, which appear to be more effective than traditional PPIs in cases of severe erosive oesophagitis. In the very recent phase 3 trial TRIUMpH-EE, presented in early May at Digestive Disease Week (DDW) 2026, tegoprazan showed higher cure rates than lansoprazole, after eight weeks of treatment, even in patients with severe forms of the disease. The drug is currently under FDA review for three different indications (treatment of heartburn in non-erosive GERD, treatment of erosive oesophagitis and maintenance therapy).

Another promising strand concerns the gut microbiome. Some studies suggest that probiotics may help reduce reflux symptoms and protect the oesophagus from damage. A Chinese study from 2026 found that adding probiotics (Lihuo, a probiotic containing several bacterial strains) to standard therapy improved symptoms by more than 36%, compared to medication alone.

Endoscopic mini-surgery: to repair anti-reflux valve

In more challenging cases, however, it is necessary to resort to endoscopic procedures or surgery.

In the surgeon's and endoscopist's sights is the lower oesophageal sphincter, the 'valve' that separates, anatomically and functionally, the stomach from the oesophagus. When this 'door' relaxes too much (often due to a bad pressure play, caused by a hiatal hernia) and therefore no longer closes properly, acidic gastric juices can rise from the stomach, causing burning and inflammation in the oesophagus.

New minimally invasive, scalpel-free endoscopic techniques can be used to reinforce this barrier. These include TIF 2.0 (Transoral Incisionless Fundoplicatio), which reconstructs the anti-reflux barrier from the inside, creating, without surgical incisions, an anti-reflux valve at the gastro-oesophageal junction. Alternatively, ARMS/ARMA procedures (mucosectomy and anti-reflux mucosal ablation), which create small, controlled scars to narrow the anti-reflux valve at the transition point between the stomach and oesophagus. Or finally, the 'Stretta' technique, which delivers radiofrequency energy to the lower oesophageal sphincter muscle and the gastro-oesophageal junction, thus causing a thickening and remodelling of the sphincter muscle.

If all this does not work, all that remains is to resort to the classic laparoscopic surgery, the 'fundoplicatio'.

The easiest cure? Move more

Finally, to return to the Chinese study, which identified regular physical activity as an important therapeutic resource, the most interesting message of this research is that reflux cannot be fought by pills (or scalpels) alone. Better sleep, weight control, reduced anxiety and exercise work and should therefore be 'prescribed' as an integral part of therapy.

According to Chinese researchers, in order to best treat reflux, it is no longer enough to limit oneself to antacid medication (or surgical solutions); a broader, 'multidimensional' approach is needed, including, where necessary, psychological support against anxiety and stress, exercise programmes and collaboration between different specialists.

However, the authors urge caution: the study in question was conducted in only one geographical area and was observational in nature. To confirm the results and better understand the cause-effect relationship between physical activity and improvement of gastro-oesophageal reflux, larger, long-term case-control studies will be needed.

In the meantime, however, one thing is clear: the stomach and the brain converse much more than we imagine. And sometimes these conversations leave their mark.