Hi,
Stress can worsen acid reflux disease symptoms.
You may follow stress relaxation techniques and take PPI also for adequate control of GERD symptoms. Lifestyle modifications also needed ( some of which you have already done)-
Lifestyle modifications -
1. Head elevation while sleeping
2. Small frequent meals
3. Going to bed 2- 3 hours after food
4. Avoiding bed time snacks
5. Avoiding smoking and alcohol
6. Avoiding tight fitting clothes
7. Avoiding cola, citrus drinks, carbonated drinks, tea, coffee, spicy food
8. Weight reduction
just to follow up on my info it has been affecting me now for 9 months straight now.