Heartburn requiring frequent antacid use may indicate significant illness.
BACKGROUND
Many otherwise healthy individuals with episodic heartburn self-medicate with over-the-counter antacids. We evaluated clinical characteristics of subjects who had never been medically diagnosed as having any upper gastrointestinal tract disorder and who used antacids for symptomatic relief of heartburn.


METHODS
Subjects with at least 3 months of frequent heartburn relieved by antacids, and with heartburn on at least 4 of 7 days during the week prior to study entry, had their medical history and gastrointestinal pathological characteristics recorded. Tests included esophagogastroduodenoscopy, esophageal motility and sensitivity studies, and 24-hour pH monitoring.


RESULTS
Of 178 subjects screened, 13 were excluded on the basis of other gastrointestinal diseases at baseline, including diffuse esophageal spasm, peptic ulcer disease, dysplastic columnar metaplasia of the esophagus (Barrett's esophagus), and adenocarcinoma. Ten subjects were ineligible because of insufficient baseline heartburn. The remaining 155 eligible subjects had heartburn for an average of 11 years. Forty-seven percent had daily symptoms and 70% described heartburn severity as moderate, even though on endoscopy most (53%) had normal-appearing esophageal mucosa (grade 0 or 1). Esophageal acid sensitivity was present in 86% of subjects. Mean lower esophageal sphincter pressures and esophageal contractile amplitudes were at the lower limits of normal and total esophageal acid contact time was slightly increased.


CONCLUSIONS
Chronic heartburn can reflect a wide range of diagnostic findings, including important underlying pathological features, and may warrant a full medical examination to detect such abnormal conditions and to permit selection of appropriate therapy.
Robinson
M
M
Oklahoma Foundation for Digestive Research, University of Oklahoma Health Sciences Center, Oklahoma City 73109-5022, USA.
Earnest
D
D
Rodriguez-Stanley
S
S
Greenwood-Van Meerveld
B
B
Jaffe
P
P
Silver
M T
MT
Kleoudis
C S
CS
Wilson
L E
LE
Murdock
R H
RH
D000230:Adenocarcinoma / Q000175:diagnosis; D000328:Adult; D000863:Antacids / Q000008:administration & dosage / Q000627:therapeutic use*; D001471:Barrett Esophagus / Q000175:diagnosis; D003937:Diagnosis, Differential; D016145:Endoscopy, Digestive System; D004938:Esophageal Neoplasms / Q000175:diagnosis; D015155:Esophageal Spasm, Diffuse / Q000175:diagnosis; D004943:Esophagogastric Junction / Q000503:physiopathology; D004947:Esophagus / Q000503:physiopathology; D005764:Gastroesophageal Reflux / Q000175:diagnosis; D006356:Heartburn / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008487:Medical History Taking; D009092:Mucous Membrane / Q000503:physiopathology; D009119:Muscle Contraction / Q000502:physiology; D004366:Nonprescription Drugs / Q000627:therapeutic use; D010437:Peptic Ulcer / Q000175:diagnosis; D010528:Peristalsis / Q000502:physiology; D010808:Physical Examination; D011312:Pressure; D012651:Self Medication; D012677:Sensation / Q000502:physiology; D012720:Severity of Illness Index
D000863:Antacids; D004366:Nonprescription Drugs