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Nighttime Heartburn a Nightmare for Millions

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WebMD Health News

May 21, 2001 (Atlanta) -- The heartburn that haunts you at night isn't the same one that makes your daytime miserable. It's usually much worse, Americans say.

Sixty million U.S. adults suffer from heartburn. And if the results of a Gallup poll of 1,000 of these people are any indication, 48 million of them have symptoms at night. The poll, presented here at the Digestive Disease Week conference by the American Gastroenterological Association, shows that the vast majority of these people -- 75% -- say their symptoms keep them awake at night.

It's not a small problem. Heartburn is one of the defining symptoms of GERD, or gastroesophageal reflux disease -- the most common disease of the esophagus. Left untreated, GERD can lead to cancer. And people with nighttime heartburn symptoms are 11 times more likely to develop cancer of the esophagus than those who do not suffer from the nighttime ailment.

"What was interesting was that nighttime heartburn sufferers had additional symptoms that in the mind of the general public are not connected to GERD -- symptoms such as throat clearing, such as chronic cough, such as asthma," study leader Reza Shaker, MD, tells WebMD. Other hallmark symptoms of GERD include acid backwash in the mouth and regurgitation of partially digested food and stomach secretions.

Although the poll respondents said that their heartburn at night was only a little worse than their daytime heartburn, nighttime symptoms made their lives much worse.

"What we found was that even though everybody has focused on daytime heartburn, the impact of heartburn at night was worse," says Shaker, who is chief of gastroenterology and hepatology at the Medical College of Wisconsin in Milwaukee. "The amazing finding here was that seven out of 10 nighttime sufferers said that heartburn affected their ability to sleep. Six out of 10 said that their ability to sleep well is disturbed -- they don't get a good night's sleep. And even more striking, 40% said this heartburn affects their ability to function the next day."

These problems seep into every aspect of the patients' lives.

"They could not sleep when and where they wanted, they could not eat what and as much as they wanted, and they couldn't socialize as they wanted," Shaker says. "Even 17% of the spouses were affected. And it is sad that four out of 10 accepted the fact that they thought there is nothing that can be done."

Nearly half of the people with nighttime heartburn said that medicine only partially helped. And many of them turned to sleeping pills as a way to get some rest.

Shaker says that the same treatments that help people with daytime heartburn can help, but the dosage and timing have to be adjusted to tailor medicines to work at night.

"Nighttime acid reflux can be very serious because our defense and clearing mechanisms are depressed when we sleep. You don't swallow -- your esophagus just stays there, and even a small amount of acid can be a big problem."

What should you do?

Shaker says to see your doctor, so he or she can investigate what the problem is and whether there is some respiratory disease that also must be addressed.

For people with longstanding problems, the doctor will have to use an instrument to look into the esophagus to make sure there is no advanced disease. Finally, after all these considerations are sorted out, the doctor can tailor the dosing of your medication to see you through the night.

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