Study data published in Medicine suggest that heartburn may potentiate the presence of sleep disturbances, anxiety, and depression among children and adolescents. In a study of young patients with functional dyspepsia (FD) and/or irritable bowel syndrome (IBS), the presence of heartburn was significantly associated with sleep difficulties and psychiatric symptoms.
Investigators conducted a cross-sectional retrospective chart review of patients aged 8 to 17 years who received care for chronic abdominal pain at a pediatric medical center in the Midwestern United States. Enrolled between 2013 and 2016, eligible patients had diagnoses of a functional gastrointestinal disorder associated with pain (FGID-AP). Patients diagnosed with another organic gastrointestinal condition were excluded.
Patients treated at the clinic completed a standardized medical history form which captured basic demographic and clinical features. Sleep quantity and quality were assessed using the parent-reported Sleep Disturbances Scale for Children (SDSC). Emotional symptoms were captured using the anxiety and depression subscales of the Behavior Assessment Symptoms for Children, 3rd edition (BASC-3).
Patients with FD and FD overlap with IBS also underwent upper endoscopy with biopsies to determine the presence of esophagitis. Questionnaire data were compared between patients with and without heartburn, as well as among other subgroups defined by sex, age, and esophagitis status.
The study cohort consisted of 260 patients, among whom 39% met criteria for FD only, 8% met criteria for IBS only, and 53% met criteria for both conditions. Heartburn was reported by 38% of patients: 27% of those with FD alone, 35% of those with IBS alone, and 46% of those with both FD and IBS (P =.018). Heartburn prevalence did not significantly differ between groups defined by age, sex, or the presence of histologic esophagitis.
Compared against patients without heartburn, those who reported heartburn had significantly greater self-reported anxiety (57.73 ± 11.46 vs 51.81 ± 10.57; P <.001) and depression (51.2 ± 10.12 vs 48.19 ± 9.94; P =.018) scores on the BASC-3. Parent-reported anxiety and depression scores were similarly elevated in the heartburn vs no heartburn group (both P <.05).
Patients with heartburn also more frequently experienced difficulties with initiating and maintaining sleep (P =.007), troubles with the sleep-wake transition (P <.001), nightmares and/or arousal during the night (P =.046), and hyperhidrosis during sleep (P =.016).
Per these data, heartburn in pediatric gastrointestinal disorders is substantially associated with sleep troubles and mental health symptoms. Study limitations include the retrospective and cross-sectional designs, which prevent the assertion of causality. Further longitudinal studies are necessary to explore the directional nature of the association between heartburn and psychiatric symptoms.
“The presence of heartburn…may signal the need for a more personalized approach to management and treatment even within the group of children with functional gastrointestinal disorders,” investigators wrote. “More broadly, this indicates that current existing classification systems may be inadequate to fully capture the nuance and needs of various FGID-AP phenotypes.”
Colombo JM, Deacy AD, Schurman JV, Friesen CA. Heartburn in children and adolescents in the presence of functional dyspepsia and/or irritable bowel syndrome correlates with the presence of sleep disturbances, anxiety, and depression. Med. Published online April 2, 2021. doi: 10.1097/MD.0000000000025426