Heartburn Fact Sheet
Incidence
- More than 60 million American adults (National Institutes of Health) and approximately 40 percent of all Americans (American Journal of Gastroenterology) experience heartburn at least once a month.
- Twenty-five million American adults suffer from heartburn daily (NIH).
- Symptoms of heartburn are more common in the elderly and women during pregnancy (American College of Gastroenterology).
- Heartburn is the most common symptom of a condition called gastresophageal reflux disease, or GERD. Approximately 21 percent of the U.S. population may suffer from GERD (International Foundation for Functional Gastrointestinal Disorders).
Financial Costs
- Patients and insurance companies in the U.S. spent an estimated $9.5 billion in 1999 on medications for heartburn and related symptoms (IMS, IRI).
- Americans spend more than half a billion dollars a year on antacids (IRI 12/99).
- The NIH estimates that GERD and related esophageal disorders, of which heartburn is a common symptom, cost the nation $1 million annually in hospitalization costs and $4 to $5 million in physician office visits (NIH).
- Heartburn costs climb even higher when calculating lost days of work and impact on productivity.
Quality of Life Impact
- A study in the American Journal of Medicine indicates quality of life scores for patients with severe GERD-related heartburn are lower than patients with congestive heart failure, coronary artery disease and diabetes mellitus.
- A 1998 Yankelovich Partners survey demonstrates heartburn's impact on frequent sufferers. In the survey, two in three frequent sufferers say heartburn has interrupted their sleep and one-third report that it has interfered with their ability to perform their jobs.
- The National Heartburn Alliance (NHBA) survey reported that one-third of all heartburn sufferers say it has prevented them from doing things they like to do, and nearly half of frequent sufferers say this occurs once a week or more often.
Cause
Heartburn is caused when stomach acid refluxes — or flows backward — into the esophagus. This generally occurs when the lower esophageal sphincter (LES) — the natural valve that keeps stomach acid in the stomach and out of the esophagus — is not functioning properly.
When functioning normally, the LES operates like a door that allows food into the stomach but not out the same way. However, at times the LES relaxes and it allows stomach juices to flow upward into the esophagus. This relaxation exposes the esophagus to the harsh acid from the stomach.
Contributing Factors/Triggers
Various lifestyle and dietary factors as well as certain medications can contribute to heartburn by 1) increasing the relaxation of the LES, causing the valve to open, 2) increasing the amount of acid produced in the stomach, or 3) making the esophagus more sensitive to harsh acid. These triggers vary from person to person. The most common contributing factors include the following:
Eating/Dietary Habits
- Eating citrus fruits, chocolate, peppermint, spearmint, tomatoes or tomato-based products, garlic, raw onions, black pepper, vinegar and fatty or spicy foods
- Drinking coffee, citrus juices, and caffeinated, carbonated or alcoholic beverages
- Eating large portions
- Eating before bedtime
Certain positions
- Lying down, especially after eating
- Bending over
Medical reasons
- Gastroesophageal reflux disease
- Pregnancy
- Hiatal Hernia
- Taking certain medications
Lifestyle habits
- Being overweight
- Smoking
- Certain types of exercise
- Stress or hectic lifestyle
- Wearing restrictive clothing
Severity
Several factors can influence severity and the frequency of occurrences of heartburn and GERD:
- Ability of the LES muscle to open and close effectively
- Type and amount of stomach juices that reflux
- Neutralizing effect of saliva
- Clearing action of the esophagus
Treatment Goals
Until recently, the primary goals of treatment for heartburn and other symptoms of GERD were to decrease the amount of reflux and reduce the damage to the lining of the esophagus. With the development of new heartburn medications, symptom elimination and prevention is the common goal and is achievable for most patients with GERD or heartburn symptoms alone.
Treatment Options
A variety of lifestyle, behavioral and dietary changes is the first line of defense. Sufferers need to identify their most common trigger substances and behaviors and subsequently try to avoid those behaviors or substances to reduce their risks of reflux.
In addition to these modifications, a wide range of non-prescription and prescription medications also can provide relief:
- Antacids neutralize some existing acid in the esophagus and stomach to provide short-term relief.
- H2 blockers or acid reducers reduce some of the acid in the stomach by blocking histamine, a substance that stimulates gastric acid secretion. They allow many patients to experience both relief and prevention of heartburn for a longer duration of time than antacids.
- Prokinetic agents speed up the emptying of stomach contents and decrease reflux.
- Proton pump (or acid pump) inhibitors, currently available by prescription, are the most effective inhibitors of acid production and work by blocking the function of the acid pump which is necessary to produce and secrete acid. They decrease both the production of acid and the volume of secretions, resulting in the prevention and elimination of heartburn symptoms associated with GERD for up to 24 hours.
People who do not get complete relief with the treatments listed above should visit their health care professional for a more complete diagnostic evaluation.
Complications
Frequent and persistent bouts of heartburn can signal a more serious condition called gastroesophageal reflux disease or GERD. GERD can be associated with esophagitis - an inflammation or irritation of the esophagus - which may lead to bleeding, ulcers or a narrowing of the esophagus from chronic scarring. GERD can also cause or contribute to asthma, pneumonia, hoarseness, chronic cough, laryngitis and dental problems.
About ten percent of GERD sufferers develop Barrett's esophagus, a condition marked by an abnormal lining of the esophagus that develops in response to acid injury. Studies indicate Barrett's esophagus is associated with an increased risk of developing esophageal cancer. Patients with Barrett's should be closely monitored by a physician.
For more information
Contact the National Heartburn Alliance at 303 East Wacker Drive, Suite 440 Chicago, IL 60601; Phone: (877) 471-2081
E-Mail: nhbainformation@heartburnalliance.org.
For a free heartburn booklet, call toll-free (877)NHBA-INFO (877-642-2463), or visit the Web site at www.HeartburnAlliance.org.
The National Heartburn Alliance is an organization dedicated to improving the lives of heartburn sufferers through education, information and support.
