Heartburn: Why Seek Help?

Blu Hamilton, 44, has had heartburn symptoms nearly every day, starting in her early 20s. Although she thinks she probably has acid reflux, she's never been diagnosed with the condition. Instead, she's learned how to control the symptoms herself, relying on yoga, meditation and avoidance of heartburn-triggering food.

Recently, she's added an over-the-counter medication to her regimen and is managing very well, thank you.

"I'm still trying to do it myself, with a little help from Western medicine," she said.

Rebecca Ames, on the other hand, started experiencing heartburn and stomach upset at a very young age. By her freshman year in college, she knew she needed help.

"It got to a point in college where I was eating Tums all the time and somebody bought me a giant oversized bottle of Tums because that was the joke—that I drank Maalox and ate Tums," she said. After a particularly severe episode in which simply drinking a soda triggered vomiting, she sought treatment.

Now 33, Ames has had an endoscopy, an examination of the esophagus and stomach with a lighted instrument that is performed on patients who have particularly severe gastroesophageal reflux disease or GERD. And she has tried every heartburn medication in the book.

"I think I've taken just about every single one of them—I've taken Axid, Prilosec, Nexium and others," she said.

Severity of symptoms

So why does one woman struggle along with over-the-counter medications and yoga, while another seeks help from a doctor? Not surprisingly, people with the most severe symptoms are most likely to see a doctor. But other factors can play a role—such as stress, psychological or social factors.

A 1999 study of 138 heartburn patients by Dr. Brian Johnston of the Royal Victoria Hospital in Belfast found that those who went to the doctor had heartburn that was more likely to interfere with their daily activities. But other factors — such as social support — also seemed to influence health-care seeking.

"Generally speaking, in these types of disorders, there is a difference between health-care seekers — we call them consulters—vs. non-consulters," said Dr. Lin Chang, an associate professor of medicine at UCLA and co-director of the Center for Neurovisceral Sciences and Women's Health. "Patients or health-care seekers typically will have more severe symptoms and usually have more psychosocial stress."

That's not to say that everyone who gets treatment for heartburn is stressed out, anxious or depressed, but such factors may spur some patients to get treatment sooner than others.

"It's not a requirement for having this disorder because there are plenty of people who have good social support and who don't have depression or anxiety or psychosocial distress," said Chang, who is an expert in stress-related gastrointestinal disorders. "But it seems to influence health-care seeking."

Strong social support basically means you have someone you feel comfortable relying on and talking to about your problem, said Chang.

"If you have someone like that, it's very positive," said Chang, "It will probably help your illness behavior and your coping and I think it lowers psychosocial distress. Your perceived distress impacts a lot on your quality of life."

Ultimately, it's pain that spurs most heartburn patients to make a doctor's appointment, "but it's really common that the reason why they are coming in and why they have a flare of their symptoms is because they are under stress, but they may not recognize it," said Chang.

In one study, University of Arizona researcher Dr. Ronnie Fass deliberately stressed patients by playing heavy-metal music and Middle Eastern music in the same set of headphones while slowly increased the amount of acid in the esophagus. The patients reported symptoms much more readily when under stress compared with sessions in which they listened to soothing, relaxing sounds.

"When you are under stress you are more bothered by it," said Chang. "There's also some evidence that if you're under stress you actually increase your acid secretion as well."

"When I'm less stressed and I'm eating right then I usually don't have a problem. I go through long periods where my belly is fine," said Ames. "But usually it takes one little drama and it all comes back again."

A trip to the doctor

While stress or other factors may spur an earlier appointment, some patients wait too long to see a doctor, said Dr. Philip E. Jaffe, the medical director of Gastrointestinal Endoscopy at the University of Connecticut Health Center in Farmington.

Because there are now many effective over-the-counter heartburn medications, "there is this potential for people to feel better and not seek medical care," he said. People who have a chronic problem with heartburn symptoms, even if it gets better with over-the-counter medicine, should seek a doctor's attention to rule out more serious problems, such as the precancerous condition known as Barrett's esophagus, said Jaffe.

"The worse thing that happens is you go see somebody and they tell you everything is fine, you don't need any special treatment, but that's very reassuring as well," he said.

Republished with permission from MSNBC.com