Dousing the fire inside A '90s kind of malady: stress, fatty diet, eating on the run can trigger heartburn

THE BALTIMORE SUN

Stephen Kaminski used to wake up at night feeling as if his chest had caught fire. The pain wasn't "like someone had put a knife into you, but it would definitely keep you awake," said the 32-year-old Abingdon resident. "I'd be tossing and turning, trying to get comfortable."

Taking an antacid often relieved the sensation, which usually occurred after Mr. Kaminski ate spicy foods or drank beer. But after the condition persisted, he finally consulted a doctor about it four years ago. He's now taking two prescription medications to control his heartburn, but finds that pain still wakes him up every couple of months.

Mr. Kaminski isn't suffering alone. Heartburn and other indigestion problems are as common as Tums commercials. In fact, 18 million adults, or one out of every eight in the United States, use indigestion aids such as antacids two or more times a week, according to a 1991 survey by the Opinion Research Corp. of Prince- ton, N.J. And 44 percent of the adult population suffers from heartburn on a monthly basis, according to a 1989 study by the Gallup Organization.

The dismal economy may be giving rise to even more of these complaints, which are usually relatively mild. Complications and more serious conditions can occur, however.

"We jokingly call [gastrointestinal problems] the 'disease of the '90s,' " said Dr. Frank Sanzaro, a family physician in Phoenix. Within the past 24 months, Dr. Sanzaro has prescribed more medicine for such problems as heartburn, gastritis and diarrhea, and scheduled more gastrointestinal examinations than he had in the six previous years -- an increase he attributes both to recession-related stress as well as greater awareness about health.

"You can see stress written on peoples' foreheads, and it seems to make for excess acid indigestion," said Dr. Sanzaro, who noted that at least a quarter of his patients complain of some type of gastrointestinal problem.

Indeed, stress is thought to play a role in many gastrointestinal problems, according to Dr. William Ravich, a gastroenterologist at the Johns Hopkins Hospital. It can cause the stomach to produce more acid than usual, which can contribute to both heartburn and to gastritis.

Heartburn occurs when stomach acids back up into the esophagus in a process called esophageal reflux. The symptoms usually consist of a burning sensation in the chest and, often, a bitter taste in the mouth. Gastritis refers to an acute inflammation of the stomach lining which is associated with the presence of a bacteria called the Helicobacter pylori. A warm, burning sensation in the stomach can often be attributed to gastritis, said Dr. Ravich.

Excess acid is also thought to aggravate irritable bowel syndrome, a condition characterized by gas, cramps and diarrhea, said Dr. Sanzaro.

Moreover, people who are under pressure may also be more likely to eat hastily, and to indulge in more fatty foods, tobacco, or alcohol -- all of which increase the likelihood of heartburn and gastritis.

"When you're under stress, you behave differently, and you eat differently," said Dr. Ravich. "Those behaviors can make reflux worse" and may also intensify gastritis.

Still, for most people, gastrointestinal problems are no more serious than a headache. Heartburn and gastritis pain may be quickly relieved by an antacid. Someone who is prone to irritable bowel syndrome may have diarrhea and cramps for a few days prior to a big deadline.

"For most people, these are nuisance problems which may cause tremendous aggravation, but which don't represent major health threats," said Dr. Ravich, who recommended consulting a doctor only if you find yourself popping antacids every day.

But for a small portion of the population, the conditions are more serious. Some experience such crushing pain in the chest that they cannot function, said Dr. David Posner, chief of gastroenterology at Mercy Medical Center. Others may develop ulcers in the esophagus as a result of reflux, and may eventually find themselves with stricture, a narrowing of the esophagus that can interfere with eating.

That's a problem Vernon Smith, 58, knows well. Because of scarring from reflux, Mr. Smith's esophagus has narrowed to the point where he frequently has trouble swallowing food. About twice a month, a piece of food -- usually meat -- gets stuck in the Middle River resident's esophagus. Often after an hour or two it goes down by itself. But occasionally, he must visit his doctor to have his esophagus dilated to dislodge the food.

"The only thing that bothers me is that my wife likes to go out to eat. But the first thing that comes into your mind when you walk into the restaurant is, is [the food] going to go down?" said Mr. Smith, who began suffering from the problem 25 years ago.

Mr. Smith is now taking medication to reduce the amount of acid produced by his stomach. But if the problem persists, he may have to undergo surgery to remove a portion of his esophagus, said his gastroenterologist, Dr. Mark Diamond, chief of gastroenterology at Franklin Square Hospital Center.

Barrett esophagus is another serious condition which stems from reflux, said Dr. Diamond. As a result of the acid entering the esophagus, the cells of this organ begin to change, resembling the cells of the stomach's lining, he said. This condition can be a precursor to cancer of the esophagus.

"These conditions are things that can happen only when [reflux] has been going on for many, many years," said Dr. Posner.

As far as gastritis is concerned, if untreated, it can eventually lead to gastric ulcers -- an erosion of the stomach's lining, said Dr. Sanzaro. A bleeding ulcer may require surgery, although medication which suppresses acid production can often do the trick.

Ulcerative colitis, a situation in which the lining of the colon becomes extremely inflamed, can be the ultimate result of irritable bowel syndrome, said Dr. Sanzaro. The bowel can cease to function as a result of the condition.

Lifestyle changes often can substantially improve gastrointestinal problems, according to Dr. Diamond. For example, cutting out fatty and spicy foods, as well as alcohol and tobacco, can reduce the occurrence of heartburn, since these substances are thought to weaken the lower esophageal sphincter, a muscle that controls the flow of acid from the stomach into the esophagus. Both regular and decaffeinated coffee stimulate the production of stomach acid, so many doctors recommend that those who suffer from gastritis, heartburn, or irritable bowel syndrome avoid it.

"I love to get a person coming in who's telling me that he's drinking 15 cups of coffee a day and has heartburn, because that's so easy to correct," said Dr. Ravich.

Changing sleeping habits can also make a difference. Doctors encourage heartburn sufferers not to lie down immediately after eating a large meal, since a prone position permits stomach acid to travel more easily into the esophagus than an upright one. Angling your bed so your head is elevated about 6 inches above your feet will discourage acid from flowing upward, said Dr. Ravich.

Moreover, weight loss can help cut down reflux, said Dr. Diamond, since extra pounds can increase intra-abdominal pressure, which intensifies reflux. And since stress can aggravate the condition, finding ways to reduce anxiety -- such as taking a short vacation -- is sometimes suggested, said Dr. Ralph Updike, chief of gastroenterology at St. Agnes Hospital.

When lifestyle changes don't work, gastroenterologists turn to medications to control these problems. Bowel muscle relaxers RTC such as dicyclomine (Bentyl) may ease irritable bowel syndrome, said Dr. Sanzaro. Cimetidine (Tagamet), ranitidine (Zantac), and omeprazole (Prilosec) all reduce the amount of acid produced by the stomach, said Dr. Posner, and are, therefore, effective in treating heartburn and gastritis.

Moreover, other drugs such as metoclopramide (Reglan) strengthen the lower esophageal sphincter, said Dr. Posner, who noted that if medication does not control the problem, surgery may be necessary.

For many people, however, medication provides the necessary relief. After beginning to take Reglan and Tagamet four years ago, Stephen Kaminski found he woke up with heartburn far less frequently. Today, eating pizza and drinking beer no longer lead to the condition. Heartburn is "still a disruption, but not as much ,, as it used to be," he said.

Don't take chances: heartburn could really be a heart attack

Not infrequently, patients are admitted to a hospital with the diagnosis of a heart attack -- only to learn that they are actually suffering from heartburn.

The mistake is understandable, according to Dr. David Posner, chief of gastroenterology at Mercy Medical Center. The esophagus and the heart are located close together in the middle of the chest, "and the body can't distinguish where the pain is coming from." Even physicians sometimes have trouble telling the difference.

Heartburn also occasionally can resemble angina pectoris, a squeezing, knifelike pain that can radiate to the back, said Dr. William Ravich, a gastroenterologist at the Johns Hopkins Hospital.

There are differences, however. Heartburn is often accompanied a sour, bitter or warm liquid washing up into the mouth, and is relieved very quickly by an antacid.

Someone suffering a heart attack, on the other hand, may feel shortness of breath, pain radiating to the face, jaw, shoulder or arms, and a feeling of impending doom, said Dr. Posner.

In general, it is best to call your doctor when you experience paiin the chest, said Dr. Posner.

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