https://biti.uz/konferensiya/konferensiya2025/index.html
21 апреля 2025 г.
110
GASTROINTESTINAL ACID-RELATED DISEASES AND ISCHEMIC
HEART DISEASE: PATHOPHYSIOLOGICAL LINKS AND CLINICAL
IMPLICATIONS
Raupov Abdurahmon Ortiq o’g’li
Bukhara State Medical Institute.
Independent PhD researcher at the
Department of Propaedeutics of Internal Diseases
orcid.org/0009-0005-6651-4500
Аnnotation.
This review summarizes key evidence on the interrelations
between gastroesophageal reflux disease, peptic ulcer disease, liver disorders,
inflammatory bowel diseases, and ischemic heart disease. It highlights both
common and specific risk factors, as well as mechanisms of comorbidity,
including those linked to standard treatments. Based on meta-analyses and large-
scale population studies, the review aims to support the improvement of current
clinical guidelines for managing comorbid conditions.
Keywords:
Comorbidity, gastroesophageal reflux disease, ischemic heart
disease, dual antiplatelet therapy, anticoagulants, aminosalicylates.
Modern medicine is dynamic and constantly evolving. However, clinical
studies that form the basis of guidelines, algorithms, and protocols often consider
comorbidity as an exclusion criterion. In real-world clinical practice, comorbid
conditions are common and complicate both diagnosis and patient management,
particularly when one disease limits the use of essential treatments for another.
While the proposed use of multiple or cumulative risk models helps manage such
cases, it does not address many of the practical challenges faced by clinicians.[1]
Gastroesophageal
Reflux
Disease
and
Ischemic
Heart
Disease.
There is now little doubt about the association between gastroesophageal reflux
disease (GERD) and ischemic heart disease (IHD). These conditions share
common risk factors, including male sex, obesity, diabetes, hypertension,
smoking, and alcohol consumption. Myocardial ischemia has been described as a
https://biti.uz/konferensiya/konferensiya2025/index.html
21 апреля 2025 г.
111
result of coronary artery spasm triggered by acidic reflux, reduced lower
esophageal sphincter pressure, and sympathetic activation. In patients with both
GERD and IHD, episodes of heartburn have been shown to coincide with
myocardial ischemia and cardiac arrhythmias. A rare phenomenon has also been
reported—mechanical compression of the left atrium by paraesophageal hernias,
which reduces cardiac blood supply and may lead to ischemia, angina, and
arrhythmias.[2]
A nationwide population-based cohort study demonstrated an association
between GERD and increased risk of IHD. The overall incidence of IHD was 82%
higher in the GERD cohort compared to those without GERD (11.8 vs. 6.5 per
1,000 person-years), with an adjusted hazard ratio (aHR) of 1.49 (95% CI: 1.34–
1.66). This association remained significant after adjusting for age, sex,
hypertension, diabetes, hyperlipidemia, alcohol-related diseases, stroke, COPD,
asthma, gallstones, anxiety, depression, chronic kidney disease, and cirrhosis.[3]
Conversely, cardiac pathology can influence GERD through various
mechanisms, including reduced regional esophageal blood flow and hypoxia due
to endothelial dysfunction, as well as upper GI dysmotility in IHD. Additionally,
standard IHD treatments—such as calcium channel blockers, nitrates, beta-
blockers, and antiplatelet agents—may negatively affect lower esophageal
sphincter tone.[4]
Proton pump inhibitor (PPI) therapy improves GERD symptoms and may
indirectly benefit IHD by reducing esophago-cardiac reflex activity. However,
prolonged PPI use has been associated with increased risks of atherosclerosis and
potential impairment of cardiac contractility.[5]
Conclusion:
Comorbid conditions, though often excluded from clinical
trials, are frequently encountered in real-world practice and complicate patient
management. Gastroesophageal reflux disease (GERD) and ischemic heart disease
(IHD) share common risk factors and show a significant bidirectional relationship.
GERD may contribute to myocardial ischemia through reflex mechanisms and
https://biti.uz/konferensiya/konferensiya2025/index.html
21 апреля 2025 г.
112
structural effects, while IHD and its treatments can exacerbate GERD symptoms.
Population-based studies confirm a significantly increased risk of IHD in GERD
patients. While proton pump inhibitors (PPIs) may alleviate GERD symptoms and
indirectly benefit cardiac function, long-term use may pose cardiovascular risks,
highlighting the need for careful therapeutic strategies in comorbid patients.
REFERENCES
1.
Wunker C. The diagnosis and treatment of peptic ulcer disease and its
complications: a review. Consultant. 2018; 58(1):10–16.
2.
Glassner K.L., Abraham B. P., Quigley E. M.M. The microbiome and infl
ammatory bowel disease. J Allergy Clin Immunol. 2020 Jan;145(1):16–27. doi:
10.1016/j. jaci.2019.11.003.
3.
Goldstone R.N., Steinhagen R. M. Abdominal Emer gencies in
Inflammatory Bowel Disease. SurgClin North Am. 2019 Dec; 99(6):1141–1150. doi:
10.1016/j.suc.2019.08.007.
4.
Simonova Zh.G., Martusevich A. K., Tarlovskaia E. I. The course of
coronary heart disease concurrent with peptic ulcer disease: Clinical and pathogenetic
aspects. Terapevticheskii Arkhiv. 2014;86(1):33–36. (In Russ.)
5.
Shiraev TP, Bullen A. Proton Pump Inhibitors and Cardiovascular Events:
A Systematic Review. Heart Lung Circ. 2018 Apr;27(4):443–450. doi: 10.1016/j.
hlc.2017.10.020.
