Observational Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 14, 2015; 21(22): 6982-6989
Published online Jun 14, 2015. doi: 10.3748/wjg.v21.i22.6982
Cardiac autonomic dysfunction in patients with gastroesophageal reflux disease
Branislav Milovanovic, Branka Filipovic, Slavica Mutavdzin, Marija Zdravkovic, Tatjana Gligorijevic, Jovana Paunovic, Marina Arsic
Branislav Milovanovic, Slavica Mutavdzin, Tatjana Gligorijevic, Jovana Paunovic, Marina Arsic, Department of Cardiology, Neurocardiology Laboratory, Clinical and Hospital Center “Bezanijska Kosa”, Belgrade 11080, Republic of Serbia
Branislav Milovanovic, Marija Zdravkovic, University of Belgrade, Medical Faculty, Belgrade 11080, Republic of Serbia
Branka Filipovic, Department of Gastroenterology, Clinical and Hospital Center “Bezanijska Kosa”, Belgrade 11080, Republic of Serbia
Marija Zdravkovic, Department of Cardiology, Clinical and Hospital Center “Bezanijska Kosa, “ Belgrade 11080, Republic of Serbia
Author contributions: Milovanovic B performed the autonomic function testing; Filipovic B performed gastroenterologic examinations; Mutavdzin S, Gligorijevic T, Paunovic J, and Arsic M collected the data; Milovanovic B, Zdravkovic M, and Mutavdzin S wrote the manuscript.
Ethics approval: This research was conducted in the frame work of the Ministry of Science project (No. 32040). Scientific Ethical Committee of Clinical Hospital Center “Bezanijska Kosa” approved all research in the frame work of this project.
Informed consent: All the patients were informed about the protocol in detail and provided written consent.
Conflict-of-interest: The research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Data sharing: Technical appendix, statistical code, and dataset available from the corresponding author at slavica.mutavdzin@gmail.com.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Slavica Mutavdzin, MD, Department of Cardiology, Neurocardiology Laboratory, Clinical and Hospital Center “Bezanijska Kosa”, Bezanijska kosa b.b., Belgrade 11080, Republic of Serbia. slavica.mutavdzin@gmail.com
Telephone: +381-11-3010773 Fax: +381-11-2606520
Received: November 27, 2014
Peer-review started: November 27, 2014
First decision: January 8, 2015
Revised: January 26, 2015
Accepted: March 27, 2015
Article in press: March 27, 2015
Published online: June 14, 2015
Abstract

AIM: To investigate autonomic nervous function in patients with a diagnosis of gastroesophageal reflux disease (GERD).

METHODS: The investigation was performed on 29 patients (14 men), aged 18-80 years (51.14 ± 18.34), who were referred to our Neurocardiology Laboratory at the Clinical and Hospital Center “Bezanijska Kosa” with a diagnosis of GERD. One hundred sixteen healthy volunteers matched in age and sex with the examinees served as the control group. The study protocol included the evaluation of autonomic function and hemodynamic status, short-term heart rate variability (HRV) analysis, 24 h ambulatory ECG monitoring with long-term HRV analysis and 24 h ambulatory blood pressure monitoring.

RESULTS: Pathologic results of cardiovascular reflex test were more common among patients with reflux compared to the control group. Severe autonomic dysfunction was detected in 44.4% of patients and in 7.9% of controls (P < 0.001). Parameters of short-term analysis of RR variability, which are the indicators of vagal activity, had lower values in patients with GERD than in the control group. Long-term HRV analysis of time-domain parameters indicated lower values in patients with reflux disease when compared to the control group. Power spectral analysis of long-term HRV revealed lower low- and high-frequency values. Detailed 24 h ambulatory blood pressure analysis showed significantly higher values of systolic blood pressure and pulse pressure in the reflux group than in the control group.

CONCLUSION: Patients with GERD have distortion of sympathetic and parasympathetic components of the autonomic nervous system, but impaired parasympathetic function appears more congruent to GERD.

Keywords: Autonomic nervous system, Blood pressure monitoring, Cardiovascular reflex test, ECG monitoring, Gastroesophageal reflux disease

Core tip: Autonomic nervous function was assessed in patients with gastroesophageal reflux disease (GERD) for the purpose of treating patients according to their presenting autonomic pattern. The results demonstrate that autonomic dysfunction is more frequently detected in patients than in controls. Parameters of short-term and long-term analysis of heart rate variability had lower value while blood pressure was higher in patients than in the controls. In conclusion, patients with GERD have distortion of both components of autonomic nervous system, but the impairment of parasympathetic function is more congruent to GERD.