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.
From the Center for Neurovisceral Sciences & Women’s Health, Departments of Medicine (M.M., L.C., L.Z.F., R.B., E.A.M.), Physiology (E.A.M.), Psychiatry & Biobehavioral Sciences (B.D.N., E.A.M.), UCLA, Los Angeles, CA; Greater Los Angeles Healthcare System, VA Medical Center (B.D.N.), Los Angeles, CA; and University of Arizona/VA Medical Center GI Division (R.F.), Tucson, AZ.
Supported in part by P50 DK64539, NR007768, and funds from AstraZeneca R&D, Sweden.
Address correspondence and reprint requests to Bruce D. Naliboff, PhD, Neuroenteric Disease Program, CURE Digestive Diseases Research Center, VA Greater Los Angeles Healthcare System, West Los Angeles, Building 115, Room 223, 11301 Wilshire Boulevard, Los Angeles, CA 90073. E-mail: firstname.lastname@example.org
Received for publication March 17, 2003; revision received December 9, 2003.