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Research shows that other risk factors for heartburn include older age, excessive body mass index (BMI), smoking, diabetes, stress, lack of sleep, anxiety/depression, and a sedentary lifestyle.
https://www.peptest.co.uk/wp-content/uploads/2021/03/2020_Boulton_et_al_A_narrative_review_of_the_prevalence_of_gastroesophageal_reflux.pdf (2021).---
Long-term shift workers may be at increased risk for GERD, but the excess risk may be explained by poor sleep quality, unhealthy behaviors, depressive symptoms, etc.
https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2023.1192517/full (2023).---
This study is very comprehensive: Dietary and Lifestyle Factors Related to Gastroesophageal Reflux Disease: A Systematic Review
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8055252/ (2021).-----
The studies clearly suggest that psychosocial stress may have a significant relationship with reflux esophagitis and may potentially play a role in symptom presentation and natural history. There is a close association between stress and reflux esophagitis, and there is a strong possibility that patients with refractory GERD may have comorbid psychosocial health problems. Stress may include increased levels and frequency of esophageal acid exposure, inhibition of gastric acid emptying, or stress-induced hypersensitivity. A mindfulness-based intervention for anxiety symptom relief and quality of life in gastroesophageal reflux disease. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3576549/ (2013).---
https://www.sciencedirect.com/science/article/abs/pii/S0016508507021713 (2008).---
https://gut.bmj.com/content/56/9/1191.short (2007)
https://mspsss.org.ua/index.php/journal/article/view/21 (2018).---
https://www.sciencedirect.com/science/article/pii/S2666149723000208 (2023).--
https://www.sciencedirect.com/science/article/pii/S2666149723000208 (2023).--
Miscellaneous Endogenous and exogenous stressors that disrupt gastrointestinal physiological functions and promote inflammation, tissue damage, ulceration, gastrointestinal bleeding, gastroesophageal reflux disease (GERD), irritable bowel disease (IBD), and gastritis.
http://www.melatonin-research.net/index.php/MR/article/view/120 (2021)
The protective role of melatonin on the gastric mucosa is due to the inhibition of gastric acid and pepsin secretion. Gastric acid and pepsin are two important invasive factors in the pathogenesis of gastric ulcers and are associated with stress-induced gastric mucosal injury. In animal models of chronic gastric fistula disease, melatonin has been observed to reduce gastric acid and also increase plasma gastrin levels.
It is suggested that this inhibitory effect of melatonin is related to the central nervous system. Melatonin is also believed to control alkaline secretion in the presence of acid in the lumen. Melatonin has been shown to protect the gastrointestinal mucosa by stimulating the production of mucosal HCO-3 by triggering the release of intracellular Ca+2 from enterochromatic cells.
In the link: ----1) Melatonin and mucosal protection and ulcer healing. ----2) Melatonin and Helicobacter pylori. ----3) Melatonin and stomach cancer. ----4) Melatonin and intestinal functions. ----5) Melatonin's effects on intestinal bacteria and the bacteria's effects on the amount of melatonin. ----6) Melatonin and irritable bowel syndrome. ----7) Melatonin and inflammatory bowel disease. ----8) Melatonin and colorectal carcinoma. ----9) The role of melatonin in liver. ---10) Melatonin and pancreas. ----11) Melatonin and appetite.
https://www.mednews.care/wp-content/uploads/2024/02/therapeutic-applications-of-melatonin-in-disorders-related-to-the-gastrointestinal-tract-and-control-of-appetite.pdf (2024).--
I used to take Pepcid AC a few years ago for acid indigestion because I think Tums may have contributed to my kidney stones. But I switched to fermented apple cider vinegar capsules which seem to work fine. I don't remember why I stopped taking Pepcid AC, something I read maybe? Anyway, I think I'll try it again since it appears safe. Hopefully it won't react badly with the methylene blue I've been taking for several months now. I remember something about not taking methylene blue if you take SSRIs so I don't know if that would apply to Pepcid AC as well. I don't get acid reflux much anymore so I won't need much.