digestive-conditions

Heartburn on the rise -- and scientists aren't sure why

Nov. 15, 2012 at 8:38 AM ET

It could be the stress, too many trips to Starbucks or the spicy chili from the food truck. The number of people plagued by heartburn is increasing -- but scientists aren’t sure why. What they do know is that highly popular acid-blocking medications don’t help everyone.

In some cases it’s because acid isn’t at the root of the heartburn –the sensation is caused by bile or food being refluxed from the stomach into the esophagus. In others it’s because people are so sensitive, they react even when the acid is greatly reduced. Still others suffer that burning pain even when there doesn’t seem to be any regurgitation at all.

A recent study in the journal Gut found that over the course of two decades there was an increase of 47 percent in the number of people who suffered weekly bouts of gastroesophageal reflux disease (GERD, the condition that most often causes heartburn). In that study, researchers led by Eivind Ness-Jensen of the Norwegian University of Science and Technologycompared data from health surveys of 58,869 Norwegians collected between 1995 through 1997 to those from 2006 to 2009.

It’s estimated that 20 percent of Americans suffer reflux at least once a week, according to the National Digestive Diseases Information Clearinghouse. And 7 percent of Americans, or about 22 million, experience daily bouts of heartburn, according to the International Foundation for Functional Gastrointestinal Disorders.

All of that digestive misery has turned heartburn medication into the second most prescribed class of drugs in the U.S., says Dr. David Metz, a professor and associate chief of clinical affairs in the division of gastroenterology at the Perelman School of Medicine at the University of Pennsylvania. Only statins outsell them.

Though the medications help many, there are some who still suffer chest pain and heartburn. A study published in August found that some 20 percent of Americans who suffer from GERD don’t respond well to the standard dose of the strongest acid blockers, known as proton-pump inhibitors. These medications, which include omeprazole, work by turning off the stomach’s acid-making structures, called proton pumps.

For some of these patients, it’s simply a matter of upping the dose, Metz says. Others might be taking the right dose, but at the wrong time. For these medications to work, they must be taken before you have your first meal – which signals the little pumps to switch on.

Take the medication as you’re going to bed and it won’t do a thing since its lifespan in your system is only about two hours.

But even when the dose is higher and the medication is taken on the right schedule, it may not help those with a super-sensitive esophagus, says Dr. Kevin McGrath, an associate professor of medicine at the University of Pittsburgh Medical Center.

“Some people have normal acid exposure and yet they feel it a whole lot more,” McGrath says. “Their nerve endings are more sensitive.”

McGrath compares the situation to irritable bowel syndrome (IBS) and suspects that stress may be a factor.

One possible solution is to try to desensitize the nerve fibers with tricyclic antidepressants, he says. Another type of antidepressant, selective serotonin reuptake inhibitors (SSRIs), can be used to decrease anxiety. “If you can decrease anxiety you may be able to cut back on the feedback loop,” he says. Prozac and Zoloft are commonly prescribed SSRIs.

A tougher problem may be those who suffer from reflux of bile and food, rather than acid. In those cases, lowering the level of acid in the stomach won’t help much, Metz says.

It may seem counterintuitive that bile and food could lead to the same kind of burning sensation that refluxed acid does, but they do, Metz says. “The esophagus has only so many ways of saying it’s unhappy,” he explains.

So, even though there might not be any real burning going on, the esophagus still senses the refluxed bile and food as a burn.

Right now, there isn’t any safe medication to treat heartburn from this kind of reflux, Metz says.

The only help may be lifestyle changes that result in lower stomach pressure, which may result in fewer episodes of reflux.

Metz suspects that some people may be helped if they consume multiple small meals rather than a few large ones. And it’s best if the meals are low fat, since fat slows down stomach emptying, he says.

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