Researchers studied over 900 people with acid reflux to understand why some people’s symptoms don’t improve even with treatment. They found that people with stubborn acid reflux tend to be older, have had the problem longer, and often deal with anxiety or depression. The good news? The study discovered that exercising for at least 90 minutes per week at a moderate level, along with managing stress and anxiety, may help reduce symptoms. This research gives doctors and patients new ideas for treating acid reflux that doesn’t respond to regular medications.

The Quick Take

  • What they studied: Why some people’s acid reflux symptoms continue even after treatment, and what factors make reflux more likely to be stubborn and hard to treat
  • Who participated: 911 adults with acid reflux from 18 different hospitals in Shanghai, China. About 28% had stubborn reflux that didn’t improve with standard treatment, while 72% had reflux that responded better to treatment
  • Key finding: People with stubborn acid reflux were more likely to have anxiety, had the condition longer, and exercised less than 90 minutes per week. Those who exercised at least 90 minutes weekly at moderate intensity were significantly less likely to have treatment-resistant reflux
  • What it means for you: If your acid reflux isn’t improving with medication alone, managing anxiety and adding regular exercise may help. This suggests that treating the whole person—not just the stomach—might be important for stubborn reflux cases

The Research Details

This was a cross-sectional study, which means researchers looked at a large group of people at one point in time rather than following them over months or years. Researchers recruited 911 patients with acid reflux from 18 different medical centers in Shanghai and asked them detailed questions about their health, lifestyle, diet, exercise habits, mental health, and quality of life. They compared people whose reflux improved with standard treatment to those whose reflux remained stubborn despite treatment. The researchers then used statistical analysis to figure out which factors were most strongly connected to having treatment-resistant reflux.

The study collected information through comprehensive questionnaires covering many aspects of each person’s life. This approach allowed researchers to identify patterns and connections between various factors and stubborn reflux. By studying such a large group across multiple hospitals, the results are more likely to apply to different populations.

Understanding why some people’s acid reflux doesn’t respond to standard treatment is important because it affects millions of people worldwide. This study helps doctors recognize which patients might need different approaches beyond just increasing medication doses. By identifying that anxiety, long disease duration, and lack of exercise are connected to stubborn reflux, doctors can now recommend lifestyle changes and mental health support alongside medical treatment.

This study has several strengths: it included a large number of participants (911 people), used multiple medical centers (reducing bias from a single location), and collected detailed information about many different factors. However, because it was cross-sectional, it shows associations but cannot prove that one thing directly causes another. The study was conducted in China, so results may vary in other populations. The researchers used validated questionnaires and statistical methods appropriate for this type of research.

What the Results Show

Among the 911 patients studied, 256 people (28%) had refractory (stubborn) GERD that didn’t improve with standard treatment, while 655 people (72%) had GERD that responded better to treatment. People with stubborn reflux were typically older and had experienced the condition for a longer time compared to those whose reflux improved with treatment.

The most important discovery was that anxiety was strongly linked to having stubborn acid reflux. People with treatment-resistant reflux were much more likely to have anxiety or depression compared to those whose reflux improved. Additionally, people with stubborn reflux reported more severe typical reflux symptoms like heartburn and regurgitation, as well as unusual symptoms that aren’t typically associated with acid reflux.

Physical activity emerged as a protective factor. People who exercised at least 90 minutes per week at moderate intensity (like brisk walking or light jogging) were significantly less likely to have treatment-resistant reflux. The study also found that people with stubborn reflux were more likely to overeat and had lower quality of life scores overall.

The research revealed that people with stubborn reflux experienced more somatic symptoms—physical complaints without clear medical causes—such as body aches and fatigue. They also reported lower overall quality of life, affecting their daily activities, sleep, and emotional well-being. The study found connections between dietary habits (particularly overeating) and stubborn reflux, though diet alone wasn’t as strong a predictor as anxiety and exercise levels.

This study builds on previous research showing that acid reflux is more complex than just stomach acid production. Earlier studies suggested that psychological factors like stress and anxiety might play a role in reflux symptoms, and this research confirms that connection. The finding about exercise as a protective factor aligns with growing evidence that physical activity helps with digestive health. However, this is one of the larger studies specifically examining why some people’s reflux doesn’t respond to standard treatment, making it a valuable addition to the scientific literature.

This study shows associations between factors and stubborn reflux but cannot prove that one thing directly causes another. Because it was a snapshot in time rather than following people over years, we can’t be certain about cause and effect. The study was conducted in China, so results might differ in other countries with different populations and healthcare systems. The study relied on people’s self-reported information through questionnaires, which can sometimes be less accurate than objective measurements. Additionally, the study didn’t examine all possible factors that might contribute to stubborn reflux, such as certain medications or specific stomach conditions.

The Bottom Line

If you have acid reflux that isn’t improving with medication: (1) Consider getting evaluated for anxiety or depression and seek treatment if needed—this appears to be one of the strongest factors in stubborn reflux (high confidence); (2) Aim for at least 90 minutes of moderate-intensity exercise per week, such as brisk walking, cycling, or swimming (moderate-to-high confidence); (3) Avoid overeating and eat smaller, more frequent meals (moderate confidence); (4) Work with your doctor to develop a comprehensive treatment plan that addresses both physical and mental health (high confidence). These recommendations should complement, not replace, your doctor’s prescribed medications.

This research is most relevant for people whose acid reflux symptoms continue despite taking standard medications. It’s also important for doctors treating patients with stubborn reflux. People with anxiety or depression who also have reflux should pay special attention to managing both conditions. However, if your acid reflux responds well to medication, these findings may be less directly applicable to you, though the exercise recommendation is beneficial for everyone.

Improvements from increased exercise and anxiety management typically take 4-8 weeks to become noticeable, though some people may see benefits sooner. Mental health treatment for anxiety may take several weeks to show effects. It’s important to be patient and consistent with lifestyle changes while working with your healthcare provider. If you don’t see improvement after 8-12 weeks of consistent effort, discuss alternative approaches with your doctor.

Want to Apply This Research?

  • Track weekly moderate-intensity exercise minutes (aim for 90+ minutes) and daily reflux symptom severity on a 1-10 scale. Also log anxiety levels and mood to identify patterns between mental health, exercise, and reflux symptoms
  • Set a goal to accumulate 90 minutes of moderate-intensity physical activity per week through activities like brisk walking, cycling, swimming, or dancing. Break this into manageable sessions (e.g., 30 minutes, 3 times per week) and log each session in the app with reminders
  • Create a weekly dashboard showing: (1) total exercise minutes completed, (2) average reflux symptom score, (3) anxiety/mood rating, and (4) meal patterns. Review trends monthly to see if increased exercise correlates with fewer reflux symptoms. Share reports with your healthcare provider to adjust treatment plans

This research describes associations between various factors and treatment-resistant acid reflux but does not establish definitive cause-and-effect relationships. The findings are based on a study conducted in China and may not apply equally to all populations. This information is for educational purposes and should not replace professional medical advice. If you have acid reflux symptoms that are not improving with current treatment, please consult with your healthcare provider before making significant changes to your treatment plan, exercise routine, or mental health care. Do not stop taking prescribed medications without medical guidance. If you experience severe chest pain, difficulty swallowing, or other concerning symptoms, seek immediate medical attention.