Systematic Reviews
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World J Gastroenterol. Jul 28, 2014; 20(28): 9592-9599
Published online Jul 28, 2014. doi: 10.3748/wjg.v20.i28.9592
Atrial fibrillation in patients with gastroesophageal reflux disease: A comprehensive review
Crina Roman, Stanislas Bruley des Varannes, Lucian Muresan, Alina Picos, Dan L Dumitrascu
Crina Roman, Dan L Dumitrascu, Division of Internal Medicine, Second Medical Clinic, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
Stanislas Bruley des Varannes, Institut des Maladies de l’Appareil Digestif, University Hospital, Hotel Dieu, 44093 Nantes Cedex 01, France
Lucian Muresan, Department of Cardiology, Rehabilitation Hospital, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
Alina Picos, Faculty of Dentistry, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400023 Cluj-Napoca, Romania
Author contributions: Roman C designed and wrote the article; Bruley des Varannes S reviewed and corrected the manuscript; Muresan L contributed with suggestions and corrected the article; Picos A contributed with suggestions; Dumitrascu DL provided the idea of writing the article, contributed to the writing of the manuscript and is the guarantor of the work.
Correspondence to: Dan L Dumitrascu, MD, Professor of Medicine, Division of Internal Medicine, Second Medical Clinic, “Iuliu Hatieganu” University of Medicine and Pharmacy, Clinicilor Street 4-6, 400006 Cluj-Napoca, Romania. dan_dumitrascu@yahoo.de
Telephone: + 40-722-756475 Fax: +40-264-593355
Received: December 25, 2013
Revised: February 9, 2014
Accepted: April 2, 2014
Published online: July 28, 2014
Abstract

AIM: To analyze the potential relationship between gastroesophageal reflux disease (GERD) and the development of atrial fibrillation (AF).

METHODS: Using the key words “atrial fibrillation and gastroesophageal reflux”, “atrial fibrillation and esophagitis, peptic”, “atrial fibrillation and hernia, hiatal” the PubMed, EMBASE, Cochrane Library, OVIDSP, WILEY databases were screened for relevant publications on GERD and AF in adults between January 1972-December 2013. Studies written in languages other than English or French, studies not performed in humans, reviews, case reports, abstracts, conference presentations, letters to the editor, editorials, comments and opinions were not taken into consideration. Articles treating the subject of radiofrequency ablation of AF and the consecutive development of GERD were also excluded.

RESULTS: Two thousand one hundred sixty-one titles were found of which 8 articles met the inclusion criteria. The presence of AF in patients with GERD was reported to be between 0.62%-14%, higher compared to those without GERD. Epidemiological data provided by these observational studies showed that patients with GERD, especially those with more severe GERD-related symptoms, had an increased risk of developing AF compared with those without GERD, but a causal relationship between GERD and AF could not be established based on these studies. The mechanisms of AF as a consequence of GERD remain largely unknown, with inflammation and vagal stimulation playing a possible role in the development of these disorders. Treatment with proton pomp inhibitors may improve symptoms related to AF and facilitate conversion to sinus rhythm.

CONCLUSION: Although links between AF and GERD exist, large randomized clinical studies are required for a better understanding of the relationship between these two entities.

Keywords: Gastroesophageal reflux disease, Esophagitis, Atrial fibrillation, Pathophysiology, Proton pump inhibitors

Core tip: The link between gastroesophageal reflux disease and atrial fibrillation is currently not understood completely. A few papers from the literature address this issue, but none has been able to draw firm conclusions. This review of the literature analyzes the potential relationship between gastroesophageal reflux disease and the development of atrial fibrillation. Five electronic databases were screened for publications on gastroesophageal reflux disease and atrial fibrillation in adults and the 8 articles found are analyzed and discussed. Although evidence on atrial fibrillation associated with gastroesophageal reflux disease exists, large randomized clinical studies are required to provide definite answers.