VIDEO: Consider sleep quality, ‘next-day functioning’ in patients with nocturnal heartburn
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In this Healio video, David A. Johnson, MD, MACG, FASGE, MACP, reminds physicians to ask patients with nocturnal heartburn or GERD about associated sleep disturbances, which can negatively affect “next-day functioning” and quality of life.
“Nocturnal heartburn is very frequent in anybody that has reflux disease,” Johnson, professor of medicine and chief of gastroenterology at Eastern Virginia Medical School, told Healio. “Survey data suggests that 80% of people with regular heartburn have nocturnal symptoms. The misguided perception is you treat these people with the typical medication as well as education about what they do.”
Although it is widely believed that those with regular heartburn symptoms at night should take medications in the evening, Johnson said, “the most effective therapy typically is one that begins with an acid blockade during the morning. Episodic heartburn can potentially be treated before an evening meal on a regular basis but, for more regular heartburn, we use a proton pump inhibitor.”
According to Johnson, untreated nocturnal heartburn contributes to sleep fragmentation, which can affect gut integrity, immune potential and upregulation of cytokines that mitigate diseases such as inflammatory bowel disease. It also may increase hunger, lead to obesity and weight loss issues, and contribute to metabolic diseases such as diabetes and fatty liver diseases. Next-day functioning, including cognitive and psychomotor performance, also can be affected.
“I view sleep as, what I call, silo mentality,” he said. “Where physicians or care providers, unfortunately, are somewhat categoric and may think about a disease state and ... [its] medication, I want to know what else I can help the patients deal with as far as contributing beneficial effects. And sleep is clearly part of that.”
However, asking only about sleep is “resoundingly” not enough, Johnson said, adding that inquiring about next-day functioning — early arousal, vitality, cognitive lapses or changes in memory and fatigue later in the day — also is critical.
“If you’re not asking these questions, you’re perhaps not giving the patients the right tools, in addition to whatever you’re addressing to afford them the best therapy,” he said.
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