Edoardo Savarino and Fabiana Zingone share co-first authorship.

No abstract

Atrial fibrillation (AF) is the most common arrhythmia in medical practice. Its incidence has risen in countries with rapidly aging populations (1). Gastroesophageal reflux disease (GERD) is a frequent benign disorder of the upper gastrointestinal tract (2). Owing to the close positioning of the esophagus and the atria and their similar autonomic innervations, it has been proposed that the development of GERD could be associated with the occurrence of AF. Sympathovagal imbalance seems to be a principal mechanism of both AF and GERD (3,4). Hiatus hernia, esophagitis, and a dilated left atrium also seem to be implicated in this association, owing to a potential mechanical effect or inflammatory process. In spite of the fact that the association between GERD and AF is supported by clinical and experimental studies, this relationship is still considered controversial (3). Most studies about the association between AF and GERD are based on retrospective data from national registries or self-reporting questionnaires (3,4)Gastrointestinal Tract Turk J Gastroenterol 2017; 28: 88-93 Atrial fibrillation and sympathovagal balance in patients with gastroesophageal reflux disease ABSTRACTBackground/Aims: Similar autonomic innervation of the esophagus and left atrium with sympathovagal imbalance seems to explain the association between non-valvular atrial fibrillation (AF) and gastroesophageal reflux disease (GERD). We aimed to assess this association via parameters of heart rate variability in time (SDNN) and frequency (low-frequency (LF)/high-frequency (HF) ratio) domains by 24-hour electrocardiographic (ECG) Holter monitoring. Materials and Methods: One hundred thirty-five patients were prospectively included by a joint team consisting of a gastroenterologist and a cardiologist on the basis of the patients' complaints. A diagnosis of GERD was assessed by the gastroenterologist clinically. All patients also underwent upper gastrointestinal endoscopy.Results: The patients were included in two groups: 61 patients with GERD (group I) and 74 patients without GERD (group II), with demographic data of 41% male, age 61.5±9 years, and body mass index (BMI) 28.8±4 kg/ m 2 versus 46% male, age 58±9 years, and BMI 29±4 kg/m 2 (all p>0.05). In groups I and II the percentages of patients with AF were 33% and 39%, respectively (p=0.52). Patients with GERD had a relative risk of AF of 1.17 (95% confidence interval [CI] 0.78-1.75; p=0.34). Heart rate variability in terms of the time-domain parameter (SDNN) was statistically significantly lower in the GERD group (97.6±13.7 ms versus 139.9±44.6 ms; p=0.001). The mean value of the frequency-domain parameter (LF/HF ratio) was also lower in the GERD group (0.75±0.17 ms versus 0.76±0.24 ms), but without statistical significance (p=0.930). Conclusion: Sympathovagal balance seems to be disrupted in patients with GERD, with dominance of the parasympathetic system and an increased risk of arrhythmias, although AF was not significantly more frequent in these patients.

Background and Aims: The nonpharmacological therapy in irritable bowel syndrome (IBS) is expanding rapidly. Practitioners and medical educators need to be aware of progress and changes in knowledge of this topic. The Romanian Society of Neurogastroenterology aimed to create guidelines based on best evidence on the use of nonpharmacological therapy in IBS. Methods: A group of experts was constituted. This was divided in eleven subgroups dedicated to eleven categories of nonpharmacological therapy. The subgroups searched the literature and formulated statements and recommendations. These were submitted to vote in order to obtain consensus. Results: The outcome of this activity is represented by the guidelines of the Romanian Society of Neurogastroenterology, presented in this paper. The recommendations are seen as complementary to the pharmacological therapy and are not intended to recommend avoiding pharmacological drugs. Conclusions: These guidelines were elaborated by a Delphi process and represent a useful tool for physicians managing patients with IBS.