Gastroesophageal Reflux Disease and Atrial Fibrillation: A Nationwide Population-Based Study

Abstract

ObjectivesPrecise mechanisms of atrial fibrillation (AF) are uncertain, but their association with esophageal disorders has been recently proposed. The association between gastroesophageal reflux disease (GERD), the most common gastroesophageal disorder, and AF remains undetermined. We therefore aimed to investigate the association between GERD and later development of AF.Methods and ResultsPatients with GERD were identified from the 1,000,000-person cohort dataset sampled from the Taiwan National Health Insurance database. The study cohort comprised 29,688 newly diagnosed adult GERD patients; 29,597 randomly selected age-, gender-, comobidity-matched subjects comprised the comparison cohort. Cox proportional hazard regressions were performed as a means of comparing the AF-free survival rate for the two cohorts. During a maximum three years of follow-up, a total of 351 patients experienced AF, including 184 (0.62%) patients in the GERD cohort and 167 (0.56%) in the control group. The log-rank test showed that patients with GERD had significantly higher incidence of AF than those without GERD (p = 0.024). After Cox proportional hazard regression model analysis, GERD was independently associated with the increased risk of AF (hazard ratio, 1.31; 95% confidence interval, 1.06–1.61, p = 0.013).ConclusionGERD was independently associated with an increased risk of future AF in a nationwide population-based cohort.

Acid reflux and head and neck cancer risk: A nationwide registry over 13 years

“…The relationship between GERD and cancers of the hypopharynx and oropharynx remains far from established [8,10]. This study succeeded in identifying a link between these two entities; however, our results should be interpreted in light of a limitation common to nationwide population-based studies [3,14,[17][18][19]21,22], namely a lack of information related to carcinogen exposure history (e.g., smoking habits, alcohol consumption, and infection with human papillomavirus) in the dataset. This makes it premature to infer a causal link between GERD and HNCs in either direction, or whether a confounding factor might account for both findings.…”

“…The validity of findings from this large-scale nationwide survey is increased through the minimization of selection bias and complete follow-up of cases. Recall bias was avoided by using a recorded history of GERD, which requires diagnostic evidence of either endoscopy or 24-h pH-meter inspection prior to treatment with proton pump inhibitors [14][15][16]. Furthermore, data regarding cancer diagnosis can be regarded as exhaustive and reliable because it was linked to the Catastrophic Illness Registry, which requires histopathologic proof of malignancy before certification [17][18][19].…”

“…As mentioned above, detailed clinical records of factors that contribute to the risk of cancer were not available in the administrative dataset. Potential confounding factors include patient characteristics, lifestyle choices (e.g., smoking or alcohol use), body mass index, and personal or family history of malignancy [3,14,[17][18][19]21,22]. We were also unable to determine the frequency or severity of acid reflux.…”

Gastroesophageal reflux disease is a predictor of atrial fibrillation recurrence following left atrial ablation

“…Gastroesophageal reflux disease (GERD) is the most common gastrointestinal diagnosis made during visits to outpatient clinics [1,2]. A potential association between GERD and atrial fibrillation (AF) development has been proposed in previous studies, mainly attributed to the close positioning of the esophagus and the left atrium [1,2].…”

“…A potential association between GERD and atrial fibrillation (AF) development has been proposed in previous studies, mainly attributed to the close positioning of the esophagus and the left atrium [1,2]. Previous studies have demonstrated a high incidence of pathologic reflux following left atrial (LA) ablation [3,4].…”