In the alphabet soup of digestive disorders, irritable bowel syndrome (IBS) and gastroesophageal reflux disease (GERD) aren’t just problematic on their own — they often occur together.
IBS causes belly pain along with changes in bowel habits, either diarrhea or constipation, or sometimes a combination of the two. GERD commonly causes acid reflux, commonly referred to as heartburn.
Several studies have found a strong link between GERD and IBS. A study published in the World Journal of Gastroenterology looked at data on more than 6,000 people and found that about 63 percent of those diagnosed with IBS had GERD symptoms, too. The research also showed that having both GERD and IBS was more common in women and that having both conditions resulted in more severe symptoms.
Another study, published in the American Journal of Gastroenterology, found that the odds of having GERD symptoms were four times greater for people living with IBS than those without IBS.
Finally, a study published in Molecular Medicine Reports in July 2019 of nearly 1,500 people with IBS found that 66 percent of participants also had GERD symptoms (much like the first study), but that GERD symptoms were higher in cases of people with IBS with constipation as the predominant symptom or both constipation and diarrhea as the predominant symptoms than those with only diarrhea as the predominant symptom.
“Is there a link between IBS and GERD? Absolutely,” says Maged Rizk, MD, a gastroenterologist and the director of the chronic abdominal pain center at the Cleveland Clinic in Ohio. “I see it all the time in our clinic. If you combine the results of all the studies, GERD is probably about four times more common in people with IBS.”
How Are IBS and GERD Linked?
Both IBS and GERD are extremely common. You may be diagnosed with IBS, which affects up to 15 percent of people, according to John Hopkins Medicine, if you have symptoms of abdominal pain at least three times a month for at least three months, and pain that cannot be explained by any disease or injury. GERD typically causes acid reflux and regurgitation; about 20 percent of people have this condition, according to the National Institute of Diabetes and Digestive and Kidney Diseases, with a smaller percentage experiencing these symptoms on a daily basis.
“The links between GERD and IBS are mostly hypothetical but probably involve an increased sensitivity of the digestive system,” Dr. Rizk says. “People with GERD and IBS become uncomfortable at a lower threshold than people without these conditions. We call that visceral hypersensitivity.”
Another link between IBS and GERD symptoms may be gastrointestinal motility, referring to the process of moving food through the digestive system, according to Mount Sinai in New York City. If the movements are abnormal, it’s called motility disorder.
Rizk says that stress is a known trigger for both IBS and GERD symptoms, as well as food sensitivities.
Treatment Options for GERD and IBS
When it comes to treating GERD and IBS, both have treatment options that involve lifestyle and dietary changes. It is best to get the most problematic condition under control first, and then work to treat the other.
“As far as GERD goes, from a nutrition and diet standpoint, we typically recommend some behavioral modifications, says Courtney Schuchmann, RD, a registered dietitian who specializes in IBD at University of Chicago Medicine. “This includes avoiding tight-fitting clothing that can push on the abdomen, as more pressure on the stomach can cause worse reflux.”
Schuchmann also says to avoid eating close to bedtime.
“When you lie flat, stomach contents can reflux back into the esophagus, so we normally recommend against eating within two to three hours of lying down,” she says. “If you can elevate the head of your bed with extra pillows or use risers, that can also prevent the reflux at night.”
Quitting smoking and maintaining a healthy weight also help with GERD management.
Dietary restrictions may be recommended, including a reduced intake of foods that may worsen GERD, like:
- Carbonated beverages
- Caffeine
- Alcohol
- Fried, spicy, or tomato-based foods
How often you eat may also matter.
“The number one recommendation we often give is to consume small, frequent meals,” says Schuchmann. “So rather than eat three large meals a day, maybe try six smaller meals throughout the day. It gives the stomach more time to empty and less opportunity for things to reflux back up.”
Medications that help with GERD include antacids, histamine blockers, and proton pump inhibitors, according to Johns Hopkins Medicine.
If IBS is the more problematic issue, some of these recommendations are the same. Certain foods (like carbonated beverages) contribute to gas and bloating, and alcohol and caffeine both speed up how quickly food travels through the GI tract. In addition, spicy, fatty, and fried foods may worsen bowel movements for some people with IBS.
Your doctor may also recommend a special diet, like the low-FODMAP diet, depending on the type of IBS you have.
Medications may also be helpful for treating symptoms of IBS. For targeting constipation (IBS-C), your doctor might prescribe Linzess (linaclotide), Amitiza (lubiprostone), or Trulance (plecanatide). For targeting diarrhea (IBS-D), your doctor may prescribe Viberzia (eluxadoline), Lotronex (alosetron oral), or Xifaxan (rifaximin).
Additionally, supplements like ibGuard and probiotics might be prescribed.
If you’re living with both IBS and GERD, it can take a while to get things under control, and it’s important to work with your doctor.
Additional reporting by Zachary Smith.
