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 c haracteristics of subjects who had never been medically diagnosed as h aving any upper gastrointestinal tract disorder and who used antacids for symptomatic relief of heartburn. Subjects and Methods: Subjects wi th at least 3 months of frequent heartburn relieved by antacids, and w ith heartburn on at least 4 of 7 days during the week prior to study e ntry, had their medical history and gastrointestinal pathological char acteristics recorded. Tests included esophagogastroduodenoscopy, esoph ageal motility and sensitivity studies, and 24-hour pH monitoring. Res ults: Of 178 subjects screened, 13 were excluded on the basis of other gastrointestinal diseases at baseline, including diffuse esophageal s pasm, peptic ulcer disease, dysplastic columnar metaplasia of the esop hagus (Barrett's esophagus), and adenocarcinoma. Ten subjects were ine ligible because of insufficient baseline heartburn. The remaining 155 eligible subjects had heartburn for an average of 11 years. Forty-seve n percent had daily symptoms and 70% described heartburn severity as m oderate, even though on endoscopy most (53%) had normal-appearing esop hageal mucosa (grade 0 or 1). Esophageal acid sensitivity was present in 86% of subjects. Mean lower esophageal sphincter pressures and esop hageal contractile amplitudes were at the lower limits of normal and t otal esophageal acid contact time was slightly increased. Conclusions: Chronic heartburn can reflect a wide range of diagnostic findings, in cluding important underlying pathological features, and may warrant a full medical examination to detect such abnormal conditions and to per mit selection of appropriate therapy.