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Gastroesophageal reflux disease (GERD) and fibromyalgia are found to have a bidirectional association. Senior author, Chia-Hung Kao, MD, and research team at the Graduate Institute of Clinical Medical Science and School of Medicine at the China Medical University in Taichung, Taiwan used data from the National Health Insurance of Taiwan to conduct a study that establishes the bidirectional connection between GERD and fibromyalgia.1
GERD and Fibromyalgia Study
The research team analyzed patients broken down into two groups. One group included 35,117 fibromyalgia patients. The second group included 34,630 GERD patients. Patients were newly diagnosed between 2000 and 2010. Control subjects from the same database were selected for comparison. The control subjects consisted of four times the subjects and contained neither GERD nor fibromyalgia patients. Adjustments to the control group were made for sex, age, medications, and the instance of the simultaneous presence of two or more chronic diseases or medical conditions.
GERD and Fibromyalgia Study Findings
- The study showed a bidirectional relationship between GERD and fibromyalgia with a slightly greater risk of fibromyalgia patients developing GERD than GERD patients developing fibromyalgia.
- The occurrence of GERD was 1.6 times greater for fibromyalgia patients than in the non-fibromyalgia control group.
- The occurrence of fibromyalgia was 1.5 times greater for GERD patients than in the non-GERD control group.
- Though patients with fibromyalgia had a slightly greater risk of developing GERD. It took longer for fibromyalgia patients to experience GERD than GERD patients to develop symptoms of fibromyalgia… GERD patients generally have a higher number of simultaneous diseases or conditions. This may explain why GERD patients seem to develop symptoms of fibromyalgia faster than fibromyalgia patients take to develop GERD.
- The risk of developing either GERD or fibromyalgia in conjunction with the other increases with age.
- GERD patients who had peptic ulcers and those taking NSAIDs were found to have a greater risk of developing fibromyalgia suggesting that greater intestinal permeability increases the risk of fibromyalgia in GERD patients.
Explanation for the Connection Between GERD and Fibromyalgia
The underlying causes of this relationship are not specifically clear. Additional studies need to be performed to determine the reasons for the connection between GERD and fibromyalgia.
Possible Factors for Fibromyalgia Patients Developing GERD
Possible factors that contribute to the development of GERD in fibromyalgia patients are lack of physical activity, weight, constipation, and gas along with psychiatric conditions like depression, anxiety, stress, exhaustion, and mood disorders caused by a lack of physical activity. How do these fibromyalgia symptoms contribute to GERD?
- Exhaustion due to physical and mental conditions can lead to a lack of physical activity which in turn may lead to mood disorders and weight gain. Being overweight is a risk factor for developing GERD… The lower esophageal sphincter (LES) is a ring of muscles at the base of the esophagus that closes to keep stomach acid out of the esophagus. Abdominal pressure caused by excess weight creates added pressure on the LES weakening the closer and allowing stomach acid to reflux through the closure into the esophagus.
- Constipation and gas also cause abdominal pressure and weaken the LES. Gas that may be belched not only causes the LES to open but can push acid into the esophagus causing heartburn.
- Anxiety and GERD have a strong connection. Anxiety can lead to GERD and the development of GERD can lead to anxious thoughts. The two can create a cycle of mental and physical discomfort that is hard to break.
- Many psychiatric medications that may be used for treating mood disorders associated with fibromyalgia can cause GERD symptoms.
- Stress raises the sensitivity of pain receptors heightening the pain associated with heartburn.
Possible Factors for GERD Patients Developing Fibromyalgia
Possible factors that contribute to the development of fibromyalgia in GERD patients are the use of a heartburn medication called a proton pump inhibitor (PPI). PPIs block stomach acid production to reduce acid irritation of the esophagus and allow healing of damage caused by acid erosion. PPIs are intended for short-term use. Many GERD patients, however, use PPIs long-term. Long-term use of PPIs can cause a great number of side effects. In relation to the development of fibromyalgia, PPIs cause a change in gut bacteria and absorption of vitamin B12 and magnesium causing deficiencies. Lack of these nutrients potentially contributes to the development of fibromyalgia.
1) Wang JC, Sung FC, Men M, Wang KA, Lin CL, & Kao CH. Bidirectional association between fibromyalgia and gastroesophageal reflux disease: two population-based retrospective cohort analysis.” National Center for Biotechnology Information, U.S. National Library of Medicine, The Journal of the International Association for the Study of Pain, October, 2017.