What are the chances that it is something more serious?

Is it related to food or maybe stress?

Occasional heartburn is so common it is not considered a sign of a serious condition. However, if you have heartburn more than twice a week, or still have symptoms even after taking over-the-counter or prescription medicines you might have gastroesophageal reflux disease, or GERD. GERD affects an estimated 5% to 7% of the global population - men, women, and children. The primary symptom of GERD is heartburn but a wide variety of secondary symptoms may also be present including regurgitation of gastric acid or sour contents into the mouth, difficult and/or painful swallowing, and chest pain. Nighttime heartburn may be even a more serious problem than symptoms experienced during the day. A recent survey estimated that eighty percent of heartburn sufferers, or nearly 50 million people, experience nighttime heartburn at least once a week, with the majority of those having symptoms severe enough to negatively impact their sleep. Nighttime heartburn is a major concern because it may cause more esophageal damage than daytime symptoms, which may lead to such conditions as erosive esophagitis (inflammation and ulceration of esophageal lining), Barrett's esophagus (a pre-cancerous condition), and esophageal cancer. A study published in the New England Journal of Medicine shows that people who experience nighttime heartburn symptoms are eleven times more likely to develop esophageal cancer than those who do not.

What causes GERD or chronic heartburn?
There is no known single cause of GERD. A major factor in creating GERD symptoms is the movement (reflux) of acidic gastric contents back into the esophagus. This may occur when the lower esophageal sphincter (LES) which acts as a protective barrier between the stomach and esophagus relaxes frequently at innappropriate times, or, less frequently, if the LES is severely compromised. Diet probably is not a primary cause of GERD. Nevertheless, patients frequently report that heartburn can be aggravated by food, in particular fatty foods. There has also been speculation that stress may aggravate heartburn by decreasing an individual's sensitivity to acid.

Stress and Heartburn
Dr. Ronnie Fass at the University of Arizona in collaboration with faculty of the Neuroenteric Disease Program has recently shown that under conditions of a laboratory stressor, acid sensitivity is increased in subjects with GERD symptoms. Under one condition he had subjects listen to two different kinds of music simultaneously (one in each ear). This laboratory protocol reliably leads to increased frustration and stress of the study subjects. In the other condition subjects listened to relaxing nature sounds. During both conditions Dr. Fass tested sensitivity to acid by slowly increasing the amount of acid in the esophagus until subjects reported the onset of heartburn symptoms. Subjects during the stress condition reported symptoms faster and at lower acid levels indicating even mild stress may change acid sensitivity in heartburn prone subjects.

In another study, UCLA investigators have been examining the relationship between naturally occurring life stress and exacerbations of heartburn. In this study subjects tracked their heartburn symptoms for two weeks every two months for six months. Subjects were also interviewed about major and minor stressors that have happened in their life over the previous months and filled out questionnaires on their mood, quality of life, and stress level. While minor stressors (often called 'daily hassles') were not associated with changes in heartburn, major life stressors were. Subjects who in the past 6 months experienced a major stress such as the onset of a very serious illness in a sibling or parent, or bereavement following the death of a sibling, parent or spouse, had higher levels of heartburn symptoms. Mood was also associated with heartburn. Subjects reporting increased anxiety or depression had higher levels of heartburn severity. The most powerful predictor of symptom intensity was a psychological measure of vital exhaustion or 'burn out'. This instrument which measures the psychological and physiological manifestations of chronic stress such as irritability, fatigue, and loss of control was highly associated with heartburn severity throughout the 6-month study. Results of this study will be presented at the American Gastrointestinal Association Meeting in Atlanta, GA in May 2001.

Therefore, we might speculate that life stress by enhancing the perceptual sensitivity to acid exposure of the esophagus and the frequency of LES relaxations, as well as the ability to cope with heartburn symptoms might play an important role in some patients' chronic symptomotology. Stress may also interfere with the patient's ability to make appropriate life-style changes (such as diet, exercise, and sleep habits) which can greatly help with mild heartburn. It is important to reiterate that anyone with chronic heartburn symptoms should have a physician evaluation to rule out the presence of more serious GERD-related conditions, and to have recommendations for the very successful medication treatments available. However in addition, or if the medical treatments are not successful, an examination of other possible trigger factors, including dietary habits, life stress or signs and symptoms of vital exhaustion, may be warranted.

For further information on GERD see the IFFGD website: www.aboutgerd.org

References:
Fass AGA 2000
Naliboff, AGA 2001