Stress and heartburn

Abstract

The majority of heartburn sufferers believe that stress exacerbates their heartburn [1]. This perception is supported by a recent study that documented that the presence of a severe sustained life stress in the previous 6 months predicted increased heartburn in the succeeding months [2]. Several groups have attempted to identify a physiological or mechanical explanation for this link, with suggestions of increased secretion of gastric acid, delayed clearance of acid from the oesophagus, or reduced lower oesophageal sphincter pressure. However, to date, no group has demonstrated an increase in any objective measure of gastro-oesophageal reflux in response to experimental stress. An alternative explanation is that stress alters the way oesophageal stimuli are perceived and reported, rather than increasing actual reflux. In such a paradigm, both the nature of the stressor and the personality characteristics of the individual experiencing the stress could influence the perception of symptoms. A study in this current issue seeks to address these questions regarding the effect of stress on objective and subjective measures of gastro-oesophageal reflux (see Page 415). Wright et al. studied 42 participants who were undergoing 24-h oesophageal pH monitoring for the investigation of their heartburn. Towards the end of this monitoring period, they were randomised into stress and control groups. Previous studies have been criticised on the basis of small sample size and use of inappropriate or inadequate stressors. Crucial to the significance of this paper are the adequate sample size and the demonstration of an effective stress response, both subjectively and by cortisone measurement.