The effect of life stress on symptoms of heartburn.

TitleThe effect of life stress on symptoms of heartburn.
Publication TypeJournal Article
Year of Publication2004
AuthorsNaliboff BD, Mayer M, Fass R, Fitzgerald LZ, Chang L, Bolus R, Mayer EA
JournalPsychosom Med
Date Published2004 May-Jun
KeywordsAdult, Aged, Anxiety Disorders, Chronic Disease, Depressive Disorder, Fatigue, Female, Gastroesophageal Reflux, Heartburn, Humans, Life Change Events, Male, Middle Aged, Personality Inventory, Quality of Life, Retrospective Studies, Severity of Illness Index, Stress, Psychological

OBJECTIVE: Psychosocial stressors have been associated with exacerbations of symptoms in functional and inflammatory disorders of the gastrointestinal tract. The present longitudinal study tests the general hypothesis that life stressors can exacerbate symptoms in patients with chronic heartburn.

METHODS: Sixty subjects with current heartburn symptoms were recruited by community advertisement and assessed for presence of stressful life events retrospectively over the preceding 6 months and prospectively for 4 months. Symptom severity by daily diary, quality of life, and psychological symptoms of anxiety, depression, and vital exhaustion were also measured.

RESULTS: The presence of a severe, sustained life stress during the previous 6 months significantly predicted increased heartburn symptoms during the following 4 months. In addition, symptoms showed a strong, independent correlation with vital exhaustion. Affective and subjective stress ratings were not strongly related to heartburn severity; however, anxiety showed the strongest relationship to impaired quality of life and depression to heartburn medication use.

CONCLUSIONS: As with other chronic conditions such as irritable bowel syndrome (IBS), heartburn severity appears to be most responsive to major life events and not an accumulation of more minor stressors or fluctuations in mood. In addition, vital exhaustion, which may in part result from sustained stress, may represent the psychophysiological symptom complex most closely associated with heartburn exacerbation. Potential mechanisms for these results include increased level and frequency of esophageal acid exposure, inhibition of gastric emptying of acid, or stress-induced hypersensitivity.

Alternate JournalPsychosom Med
PubMed ID15184707
Grant ListNR007768 / NR / NINR NIH HHS / United States
P50 DK64539 / DK / NIDDK NIH HHS / United States