title: The effect of life stress on symptoms of heartburn.
abstract: OBJECTIVE
  Psychosocial stressors have been associated with exacerbations of symptoms in functional and inflammatory disorders of the gastrointestinal tract. The present longitudinal study tests the general hypothesis that life stressors can exacerbate symptoms in patients with chronic heartburn.
  
  
  METHODS
  Sixty subjects with current heartburn symptoms were recruited by community advertisement and assessed for presence of stressful life events retrospectively over the preceding 6 months and prospectively for 4 months. Symptom severity by daily diary, quality of life, and psychological symptoms of anxiety, depression, and vital exhaustion were also measured.
  
  
  RESULTS
  The presence of a severe, sustained life stress during the previous 6 months significantly predicted increased heartburn symptoms during the following 4 months. In addition, symptoms showed a strong, independent correlation with vital exhaustion. Affective and subjective stress ratings were not strongly related to heartburn severity; however, anxiety showed the strongest relationship to impaired quality of life and depression to heartburn medication use.
  
  
  CONCLUSIONS
  As with other chronic conditions such as irritable bowel syndrome (IBS), heartburn severity appears to be most responsive to major life events and not an accumulation of more minor stressors or fluctuations in mood. In addition, vital exhaustion, which may in part result from sustained stress, may represent the psychophysiological symptom complex most closely associated with heartburn exacerbation. Potential mechanisms for these results include increased level and frequency of esophageal acid exposure, inhibition of gastric emptying of acid, or stress-induced hypersensitivity.
authors.affiliation: Center for Neurovisceral Sciences & Women's Health, Department of Medicine, UCLA, Los Angeles, CA, USA. naliboff@ucla.edu
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Naliboff
authors.forename: Minou
authors.initials: M
authors.lastname: Mayer
authors.forename: Ronnie
authors.initials: R
authors.lastname: Fass
authors.forename: Leah Z
authors.initials: LZ
authors.lastname: Fitzgerald
authors.forename: Lin
authors.initials: L
authors.lastname: Chang
authors.forename: Roger
authors.initials: R
authors.lastname: Bolus
authors.forename: Emeran A
authors.initials: EA
authors.lastname: Mayer
mesh_terms: D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000175:diagnosis / Q000523:psychology; D002908:Chronic Disease; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology; D005221:Fatigue / Q000175:diagnosis / Q000523:psychology; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000523:psychology; D006356:Heartburn / Q000175:diagnosis* / Q000523:psychology; D006801:Humans; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D010555:Personality Inventory; D011788:Quality of Life; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000175:diagnosis / Q000523:psychology