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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 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 of 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).-----

Studies clearly suggest that psychosocial stress could have a significant relationship with reflux esophagitis and could potentially play a role in symptom presentation and natural history. There is a strong association between stress and reflux esophagitis and the strong possibility that patients with refractory GERD may have comorbid psychosocial health problems. Stress may include an increased level and frequency of exposure to esophageal acid, inhibition of gastric acid emptying, or stress-induced hypersensitivity. A mindfulness-based intervention for the relief of anxiety symptoms 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).--

Various 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 the secretion of gastric acid and pepsin. Gastric acid and pepsin are two important invasive factors in the pathogenesis of gastric ulcers and are associated with stress-induced gastric mucosal lesions.

It has been observed that in animal models of chronic gastric fistula, melatonin reduced gastric acid and also increased plasma levels of gastrin.

It is suggested that this inhibitor of the 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 causing the release of intracellular Ca+2 in 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).--

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