SA's high stress increases heartburn, acid reflux

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According to recent poll by Pharma Dynamics, more than 1.5 million South Africans (2% of the population) suffer from this uncomfortable condition daily and the figure is growing annually. Globally there has also been a rise in oesophageal adenocarcinoma, the most common form of cancer of the oesophagus, which is strongly linked to chronic heartburn.

Mariska van Aswegen, spokesperson for Pharma Dynamics, says the worry about chronic acid reflux is that years of exposure to stomach acids can trigger changes in the lining of the oesophagus, a condition known as Barrett's oesophagus, which may over time lead to cancer.

"The most effective treatment for chronic heartburn is proton pump inhibitors (PPI), which limit the amount of acid the stomach produces but less expensive, over-the-counter (OTC) antacids are also available."

Interesting to note, is that 75% of pharmacists who participated in the company's national poll indicated that apart from spicy or fatty food, patients often attribute the cause of their heartburn to 'stress'. Over 95% of pharmacists also confirmed that more patients are complaining of heartburn symptoms and fill scripts for PPI and other related medications for the treatment of acid reflux compared to a decade ago.

Stress, exhaustion contribute to condition

While it may be true that South Africa rates among the 'most stressed' nations in the world, is the increasing demand and stress of modern life the likely culprit behind the growing incidence of heartburn.

Van Aswegen cites a study done some years back which involved 2 000 participants where both men and women reported a spike in acid reflux after a busy day at home or the office, when traveling for business or working extended hours. Heartburn severity also appears to be linked to major life events and other studies point out that exhaustion, in particular, is very closely associated with a worsening of acid reflux symptoms.

She says poor diet and lifestyle choices such as lack of exercise and smoking contributes to heartburn, but that stress has the added effect of making one feel the symptoms of acid reflux more intensely than one otherwise would.

Stress increases perception of reflux

"The verdict is still out about whether or not stress increases the production of stomach acid but we live in stressful times and heartburn is becoming incredibly common. Stress affects our overall gastrointestinal health, but some experts argue that patients who experience a lot of work or emotional stress may say they suffer from more severe reflux symptom, without necessarily having more acute reflux.

"People who are stressed-out tend to be more sensitive to and have a greater awareness of physical symptoms that may not otherwise bother them if they weren't as stressed. This is referred to as 'hyper vigilance'.

"The Journal of Psychosomatic Research conducted a study in 2005 where researchers measured the oesophageal acid levels in 40 patients that suffered from heartburn. During the experiment, researchers induced stress in half of the participants by asking them to prepare and deliver a speech. The acid levels in both groups were almost identical, but interestingly, patients in the 'stressed' group reported more intense heartburn symptoms, suggesting that their sensitivity to their symptoms had been heightened.

"Experts suggest that stress could stimulate areas of the brain that may in turn make pain receptors in the oesophagus more active. Therefore, while acid levels may not rise that much more in people who are stressed, each drop of acid may just become that much more agonising.

"People who are stressed can also have a drop in hormone-like substances, called prostaglandins, which can help coat the lining of the stomach and protect it from acid. Certain medications can block the production of prostaglandins, including anti-inflammatory drugs such as ibuprofen and naproxen.

"No matter which way you look at it, there is a strong connection between stress and heartburn. It doesn't matter how the body and brain senses them, acid reflux symptoms are equally real," she says.

De-stressors

Van Aswegen shares a few stress-relief methods that may reduce the symptoms of heartburn:

• Do whatever calms you down - it can be as simple as listening to your favourite music.
  
• Take some time out of the office or any other stressful environment you may find yourself in.
  
• Do something that you really enjoy, whether it's playing golf, pottering in the garden or any other hobby that you find relaxing.
  
• Exhaustion may exacerbate heartburn symptoms, so be sure to get enough shut-eye and try to sleep elevated.
  
• Get moving - exercise helps loosen up tight and tense muscles or go for a massage.
  
• Learn to say no and prioritise people and activities.
  
• Laugh more!
  
• Talk to a therapist or good friend which can help alleviate stress and put things in perspective again.
  
• If you're stressed rather opt for healthier and less fatty food options. Stay away from spicy foods, chocolate, citrus fruits, tomatoes and caffeine.

View the stressed nations' results here.