Reflux esophagitis is associated with higher risks of acute stroke and transient ischemic attacks in patients hospitalized with atrial fibrillation

Abstract

Reflux esophagitis (RE) is a subset of gastroesophageal reflux disease (GERD) with endoscopic evidence of esophageal inflammation, which has been linked to an increased incidence of atrial fibrillation (AF). However, data on the effect of RE on patient outcomes is limited. We sought to examine the potential association of RE with outcomes of patients with AF in a nationwide study. The National Inpatient Sample (NIS) database was queried to identify hospitalized adult patients with AF and RE between 2010 and 2014. Primary outcomes included inpatient mortality, length of stay (LOS), and total hospital charges. AF related complications such as acute stroke, transient ischemic attack (TIA) and acute heart failure were assessed as secondary outcomes. Propensity score matching and multivariate regression analysis were used. Six lakh sixty seven thousands five hundred twenty patients were admitted for primary diagnosis of AF out of which 5396 had a secondary diagnosis of RE. In the AF with RE cohort, the average age was 73.6 years, 41.5% were male, and 79.9% were Caucasian. There was a greater prevalence of concomitant dyslipidemia, chronic liver disease and chronic pulmonary disease ( P < .01) when compared to the AF without RE cohort. Patients with AF and RE also had higher incidence of acute strokes and TIAs ( P < .05), longer LOS ( P < .001), and higher hospital charges ( P < .05) with no difference in acute heart failure ( P = .08), hospital mortality ( P = .12), or CHA 2 DS 2 -VASc score ( P = .67). In hospitalized patients with AF, RE was associated with a higher rate of acute stroke and TIAs, longer LOS, and greater hospital charges.

Gastrointestinal syndromes preceding a diagnosis of Parkinson’s disease: testing Braak’s hypothesis using a nationwide database for comparison with Alzheimer’s disease and cerebrovascular diseases

“…49 Prospective studies are necessary to investigate this association and to establish whether anti-TNF therapy can effectively protect against PD. Notably, concordant with an earlier study that linked reflux oesophagitis to an increased risk of stroke and transient ischaemic attack in patients with atrial fibrillation, 21 the risk of CVD in our study was significantly greater after a diagnosis of GORD, CD and MC. These findings suggest that a better understanding of the link between GI inflammation and cerebrovascular events may lead to improved risk stratification and identification of new preventive strategies.…”

“…These findings suggest that a better understanding of the link between GI inflammation and cerebrovascular events may lead to improved risk stratification and identification of new preventive strategies. 21 After Grey et al first discovered that α-synuclein was most abundant in the appendiceal mucosa, 9 conflicting evidence has emerged about the impact of an appendectomy on PD risk. While three studies did not find any association, 11 14 50 one abstract reported an increased risk of PD 13 and two large observational studies supported a protective effect.…”

“…17 A strong pathological link between microbiome derived neurotoxins, including Escherichia coli derived Lipopolysaccharide, has been established with disrupted intestinal cell adhesion, impaired synaptic signalling in the Alzheimer's disease (AD) brain and exacerbation of inflammatory neuropathology. 18 19 Additionally, given the prominent role of reactive oxygen species induced inflammation in cerebrovascular diseases (CVD), 20 proinflammatory intestinal 21 and extraintestinal 22 diseases have been linked to a higher risk of CVD than that predicted by conventional risk factors. 20 Previous studies on this topic have been limited by small sample sizes and inadequate controls.…”

Association between gastroesophageal reflux disease and stroke: a bidirectional Mendelian randomization study

“…Therefore, further exploration of the potential relationship between the two diseases is increasingly important to prevent and treat them. Several clinical observational studies in recent years have shown that GERD can increase the risk of stroke in different groups of people, such as regular GERD patients, young adult GERD patients, and GERD patients with atrial fibrillation ( 7 , 8 , 21 ). Similarly, a population-based cohort study also found that stroke patients had a higher risk of GERD ( 6 ).…”

“…A population-based follow-up study suggests that young patients with gastric reflux esophagitis are at higher risk of stroke ( 7 ). An analysis of inpatient samples also found that reflux esophagitis increased the incidence of acute stroke in patients with atrial fibrillation ( 8 ). It has long been considered that there may be a link between GERD and stroke.…”