GERD linked to atrial fibrillation

I 've noticed quite a few new afibbers to the forum linking stomach issues to their LAF and wondering why? So out of interest I have reposted this from Hans Larsen, our afibbers.org founder, from 2006.

Dean


Hans Larsen
Re: GERD Symptoms Linked to Cardiac Dysrhythmias
October 19, 2006 02:28PM

The following excerpt from the July/August 2004 issue of The AFIb Report may also be of interest re. the GERD connection:

"GERD linked to atrial fibrillation
VIENNA, AUSTRIA. Austrian medical researchers have confirmed a strong connection between GERD (gastroesophageal reflux disease) and lone atrial fibrillation (LAF). Their pilot study involved 89 patients (93% men) between the ages of 39 and 69 years who had been diagnosed with GERD. Eighteen of the patients had also been diagnosed with paroxysmal LAF at least 3 months prior to undergoing gastroscopy to check for the presence of GERD. Immediately upon diagnosis the GERD-positive patients were prescribed proton pump inhibitors (lansoprazole, omeprazole, pantoprazole).

After at least 2 months on their medications, the 18 patients were invited for a follow-up visit to review and compare the severity of LAF and GERD symptoms before and after beginning the medication. The LAF symptoms evaluated were frequency and duration of palpitations, presence of dizziness or weakness, and breathing difficulties upon exertion. An astounding 14 out of the 18 (78%) patients reported a decrease or complete disappearance of one or more LAF symptoms. Fewer episodes (palpitations) were reported by 55% and shorter episodes by 39%. Twenty-two per cent reported no change in episode frequency, while 2 patients (11%) reported an increase in episode frequency. An impressive 28% of all patients were able to discontinue their antiarrhythmic drugs and no patients had to increase their dosage of antiarrhythmic drugs or be prescribed new ones. An electrocardiogram recorded at the time of the follow-up visit showed all patients to be in normal sinus rhythm.

GERD involves a local inflammatory process that manifests itself as heartburn, regurgitation and difficult or painful swallowing. The researchers believe that it is the inflammation that affects LAF severity. They suggest several possible mechanisms:

• The local inflammation penetrates the esophageal wall and affects adjacent vagal nerves making them overly sensitive.
• The inflammatory process results in feedback to the brain leading to over-stimulation of the parasympathetic (vagal) branch of the autonomic nervous system. Vagal over-stimulation may lead to bradycardia and subsequent AF.
• The local inflammatory process penetrates the esophageal wall and spreads to the heart resulting in atrial myocarditis (inflammation of the wall of the atria). Biopsies in LAF patients have revealed that 66% of them suffer from myocarditis.
• GERD may lead to the release of inflammatory mediators such as C-reactive protein (CRP). Many LAF patients reportedly have high CRP levels.
• GERD may induce an autoimmune response that contributes to LAF.

It is interesting that the researchers make a clear distinction between vagal, adrenergic and mixed afibbers. They define vagal afibbers as those whose episodes begin during rest, at night or after a meal. Adrenergic afibbers are defined as those whose episodes occur during the day, during exercise or while under stress. Mixed afibbers experience episodes that can be either vagally or adrenergically initiated. According to these definitions, 4 of the patients were purely vagal, 1 was purely adrenergic, and the remaining 13 were mixed (4 mostly adrenergic and 4 mostly vagal). There was a definite trend for proton pump inhibitor therapy to be more effective in vagal or primarily vagal afibbers. The researchers conclude that LAF patients should be checked for GERD and, if positive, should be treated with proton pump inhibitors.
Weigl, M, et al. Reflux esophagitis in the pathogenesis of paroxysmal atrial fibrillation. Southern Medical Journal, Vol. 96, November 2003, pp. 1128-32

Editor’s comment: The 3rd LAF survey in August 2002 revealed that about a third of the 100 respondents experienced GERD episodes on a daily (10%), weekly (14%) or monthly (10%) basis. This incidence rate is no different from the rate found in the general population. However, 69% of afibbers with GERD had noticed a strong correlation between a flare-up of GERD symptoms and the initiation of an AF episode or a worsening of permanent symptoms. The survey concluded that, “GERD could be an important trigger for LAF and its elimination could materially improve the condition of some afibbers.” It is indeed gratifying to see the Austrian researchers confirm this conclusion."

Hans

It's interesting, but with limitations.
The most obvious is the short term analysis of the effects of PPI drugs. We know they have a strong effect on GERD symptoms, but long term effects are disastrous for the digesting process.
I experienced this.

Everyone i know who have taken PPIs for 20-30 years (some of them now in their 70s) have had no adverse issues whatsoever. Sometimes taking a PPI is simply the lesser of the available evils. Here's a 2017 review in laymans' terms:

[healthblog.uofmhealth.org]

Clearly hypomagnesaemia is a concern to AFrs though...

Here's a detailed 2018 study from the Health Authority for Wales in the UK:

[www.awmsg.org]

I take them myself, but only 15mg every other day or so in conjunction with trying to eat as healthily as I can. I often go for as long a periods as I can without taking them at all.

Lastly; here's a study by the NHS here in the UK from 07/17 that seems to be quite balanced.

[www.nhs.uk]

Quote
mwcf
(...) I take them myself, but only 15mg every other day or so in conjunction with trying to eat as healthily as I can. I often go for as long a periods as I can without taking them at all.

Lastly; here's a study by the NHS here in the UK from 07/17 that seems to be quite balanced.

I agree with this. I find my PPI drug OK when taken ponctually (say, for a couple of days) in case of obvious GERD symptoms. I try eating healthily too, but it's sometimes a bit uneasy.
I don't doubt there are lots of patients being fine with those drugs. I myself know some people who wouldn't even stop taking PPIs without quickly feeling very bad. My best friend is a pantoprazole "addict" and he has no other choice to avoid carcinoma.
OTOH, I think PPIs are too often prescribed to patients who don't really need them. Of course, they may feel better with them, so they believe they have to take them but they create some sort of addiction. They can't stop taking PPIs.

Michael Murray, ND, wrote about risks with PPIs in 2015 and 2016... many other functional nutrition medicine type physicians have also offered warnings based on the study observations. It's known that often the GERD issues come from inadequate nutrients that support producing one's own stomach acid. The second report indicates a potential association with hypomagnesia which would definitely be detrimental for afibbers.


Intro to Summary Report on PPI Side Effects dated 1/16/18....

Top Five Reasons NEVER to Take PPIs
Millions of doses of "acid blocking" proton pump inhibitor drugs are doled out every year, yet most doctors and their patients are completely oblivious to their unintended, adverse effects, which include increased risk for premature death.

Proton pump inhibitors are a type of drug commonly known as acid-blockers, whose primary purpose is to reduce the amount of gastric acid secreted in the stomach wall. Available with or without a prescription, acid-blockers are used to treat common disorders such as indigestion, heartburn, acid reflux, and various ulcers. These types of digestive disturbances are so common, proton pump inhibitors, or PPIs, were prescribed at nearly 270 million hospital trips made by adults via ambulance from 2006 to 2010.[1] The standard American diet of sugar-laden, highly-acidic processed foods, and the stress-filled lifestyle that accompanies it, make it easy to swallow the fact that PPIs are among the most highly prescribed drugs on the planet.

Economically, the boost these drugs represent to pharmaceutical companies cannot be overstated. With cumulative sales of more than $10 billion dollars annually, drugs like Nexium, Prilosec, Prevacid, and others, represent a significant chunk of Big Pharma’s profits.[2] Despite clinical research that shows an act as simple as drinking more water reduces stomach acid more than these drugs, and does so safely with no negative side effects, Big Pharma’s relationship with the corner doctor’s office too often prevents these basic self-help practices from being disseminated.

PPIs work by raising stomach pH above normal range to inhibit secretion of pepsin, a digestive enzyme that can be irritating to stomach lining. While this action may provide temporary feelings of relief, it effectively blocks secretion of normal, healthy enzymes, impairing the body’s digestive function over the long-term. Lack of adequate stomach secretions can also expose us to harmful molds, viruses, and bacteria that may be present in our food.
Continue: [www.greenmedinfo.com]


6/16/15
Acid-Blocking Drugs Increase Heart Disease Risk

Introduction

Prproton-pump inhibitorsoton-pump inhibitors (PPIs) are a group of drugs whose main action is blocking the secretion of gastric acid. They are dominant medical treatment of peptic ulcers, gastroesophageal reflux disease (GERD), and indigestion. Popular examples include Nexium, Prilosec, Protonix, Prevacid, and Aciphex. Use of these powerful antacids is associated with an increased risk for osteoporosis, heart arrhythmias, intestinal infections, bacterial pneumonia, and multiple nutrient deficiencies. A new study from Stanford University adds another issue with these drugs – they double the risk of dying from a heart attack or stroke.

Background Data:

PPIs will typically raise the gastric pH above the normal range of 3.5, effectively inhibiting the action of pepsin – an enzyme involved in protein digestion that can be irritating to the stomach. Although raising the pH can reduce symptoms, it also substantially blocks a normal body process. The manufacture and secretion of stomach acid is very important not only to the digestive process, but also because it is an important protective mechanism against infection. Stomach secretions can neutralize bacteria, viruses and molds before they can cause gastrointestinal infection.

As far as the digestive process, stomach acid is not only important in the initiation of protein digestion, it ionizes minerals and other nutrients for enhanced absorption; and without sufficient secretion of HCl in the stomach the pancreas does not get the signal to secrete its digestive enzymes.
Continue: [doctormurray.com]



Abstract Title:

The association between the use of proton pump inhibitors and the risk of hypomagnesemia: a systematic review and meta-analysis.

Abstract Source: PLoS One. 2014 ;9(11):e112558. Epub 2014 Nov 13. PMID: 25394217

Abstract Author(s): Chan Hyuk Park, Eun Hye Kim, Yun Ho Roh, Ha Yan Kim, Sang Kil Lee

Abstract:
BACKGROUND: Although many case reports have described patients with proton pump inhibitor (PPI)-induced hypomagnesemia, the impact of PPI use on hypomagnesemia has not been fully clarified through comparative studies. We aimed to evaluate the association between the use of PPI and the risk of developing hypomagnesemia by conducting a systematic review with meta-analysis.

METHODS: We conducted a systematic search of MEDLINE, EMBASE, and the Cochrane Library using the primary keywords" proton pump,""dexlansoprazole,""esomeprazole,""ilaprazole,""lansoprazole,""omeprazole,""pantoprazole,""rabeprazole,""hypomagnesemia,""hypomagnesaemia,"and"magnesium."Studies were included if they evaluated the association between PPI use and hypomagnesemia and reported relative risks or odds ratios or provided data for their estimation. Pooled odds ratios with 95% confidence intervals were calculated using the random effects model. Statistical heterogeneity was assessed with Cochran's Q test and I2 statistics.

RESULTS: Nine studies including 115,455 patients were analyzed. The median Newcastle-Ottawa quality score for the included studies was seven (range, 6-9). Among patients taking PPIs, the median proportion of patients with hypomagnesemia was 27.1% (range, 11.3-55.2%) across all included studies. Among patients not taking PPIs, the median proportion of patients with hypomagnesemia was 18.4% (range, 4.3-52.7%). On meta-analysis, pooled odds ratio for PPI use was found to be 1.775 (95% confidence interval 1.077-2.924). Significant heterogeneity was identified using Cochran's Q test (df = 7, P<0.001, I2 = 98.0%).

CONCLUSIONS: PPI use may increase the risk of hypomagnesemia. However, significant heterogeneity among the included studies prevented us from reaching a definitive conclusion.

Article Published Date : Dec 31, 2013



Just a few of many similar reports.... FYI.


Jackie

I can only report improvement after stopping PPIs over a year ago.

Remember that PPIs have a nasty rebound effect on stomach acid. You can expect reflux to increase for up to two weeks after cessation, even when titrating down carefully. Never stop them "cold turkey".

Been on various GERD-related drugs since having afib. YEARS on some of them. No change in afib. Would have been nice.
Nancy

People diagnosed with GERD are usually prescribed a PPI drug and, in the same time, some behaviour adaptations are suggested.
Those modifications might have a strong effect on afib too...

This is a very interesting thread to me, having recently started experiencing a clear change in my digestive.. process, shall we say? Lots of reflux, difficulty swelling at least once during every meal, occasional chest pain and tightness under left breastbone. Last night I (stupidly) ate a few sugary snacks before bed. I experienced a lot of sensations and "movement", genuinely felt like something was expanding as it passed through my system and this seemed to cause a couple of unnerving runs of ectopics and palpitations that felt like they may convert to full-on afib (lasted for literally seconds) when I lay back to go to sleep.

I'd been considering a trip to my GP for these recent symptoms but now I'm convinced I need to go.