Stephen Kaminski used to wake up at night feeling as if his chest had caught fire. The pain wasn't "like someone had put a knife into you, but it would definitely keep you awake," said the 32-year-old Abingdon resident. "I'd be tossing and turning, trying to get comfortable."
Taking an antacid often relieved the sensation, which usually occurred after Mr. Kaminski ate spicy foods or drank beer. But after the condition persisted, he finally consulted a doctor about it four years ago. He's now taking two prescription medications to control his heartburn, but finds that pain still wakes him up every couple of months.
Mr. Kaminski isn't suffering alone. Heartburn and other indigestion problems are as common as Tums commercials. In fact, 18 million adults, or one out of every eight in the United States, use indigestion aids such as antacids two or more times a week, according to a 1991 survey by the Opinion Research Corp. of Prince- ton, N.J. And 44 percent of the adult population suffers from heartburn on a monthly basis, according to a 1989 study by the Gallup Organization.
The dismal economy may be giving rise to even more of these complaints, which are usually relatively mild. Complications and more serious conditions can occur, however.
"We jokingly call [gastrointestinal problems] the 'disease of the '90s,' " said Dr. Frank Sanzaro, a family physician in Phoenix. Within the past 24 months, Dr. Sanzaro has prescribed more medicine for such problems as heartburn, gastritis and diarrhea, and scheduled more gastrointestinal examinations than he had in the six previous years -- an increase he attributes both to recession-related stress as well as greater awareness about health.
"You can see stress written on peoples' foreheads, and it seems to make for excess acid indigestion," said Dr. Sanzaro, who noted that at least a quarter of his patients complain of some type of gastrointestinal problem.
Indeed, stress is thought to play a role in many gastrointestinal problems, according to Dr. William Ravich, a gastroenterologist at the Johns Hopkins Hospital. It can cause the stomach to produce more acid than usual, which can contribute to both heartburn and to gastritis.
Heartburn occurs when stomach acids back up into the esophagus in a process called esophageal reflux. The symptoms usually consist of a burning sensation in the chest and, often, a bitter taste in the mouth. Gastritis refers to an acute inflammation of the stomach lining which is associated with the presence of a bacteria called the Helicobacter pylori. A warm, burning sensation in the stomach can often be attributed to gastritis, said Dr. Ravich.
Excess acid is also thought to aggravate irritable bowel syndrome, a condition characterized by gas, cramps and diarrhea, said Dr. Sanzaro.
Moreover, people who are under pressure may also be more likely to eat hastily, and to indulge in more fatty foods, tobacco, or alcohol -- all of which increase the likelihood of heartburn and gastritis.
"When you're under stress, you behave differently, and you eat differently," said Dr. Ravich. "Those behaviors can make reflux worse" and may also intensify gastritis.
Still, for most people, gastrointestinal problems are no more serious than a headache. Heartburn and gastritis pain may be quickly relieved by an antacid. Someone who is prone to irritable bowel syndrome may have diarrhea and cramps for a few days prior to a big deadline.
"For most people, these are nuisance problems which may cause tremendous aggravation, but which don't represent major health threats," said Dr. Ravich, who recommended consulting a doctor only if you find yourself popping antacids every day.
But for a small portion of the population, the conditions are more serious. Some experience such crushing pain in the chest that they cannot function, said Dr. David Posner, chief of gastroenterology at Mercy Medical Center. Others may develop ulcers in the esophagus as a result of reflux, and may eventually find themselves with stricture, a narrowing of the esophagus that can interfere with eating.
That's a problem Vernon Smith, 58, knows well. Because of scarring from reflux, Mr. Smith's esophagus has narrowed to the point where he frequently has trouble swallowing food. About twice a month, a piece of food -- usually meat -- gets stuck in the Middle River resident's esophagus. Often after an hour or two it goes down by itself. But occasionally, he must visit his doctor to have his esophagus dilated to dislodge the food.
"The only thing that bothers me is that my wife likes to go out to eat. But the first thing that comes into your mind when you walk into the restaurant is, is [the food] going to go down?" said Mr. Smith, who began suffering from the problem 25 years ago.