Association between atrial fibrillation and elevated risk of gastroesophageal reflux disease and complications in individuals under 50 years of age

Abstract

Background: Atrial fibrillation (Afib) and gastroesophageal reflux disease (GERD) are common conditions in hospitalized
patients, yet there is limited evidence suggesting a direct relationship between them. This study aims to explore the
correlation between Afib and GERD, as well as GERD-related complications such as esophageal strictures, Barrett's
esophagus, and esophageal cancer, with age as a key factor of reference. Methods: A population-based analysis was
performed using data from the National Inpatient Sample (NIS) from 2017 to 2019. Patients diagnosed with GERD were
divided into groups based on whether they had a concurrent diagnosis of Afib or not and were compared with patients
without GERD. Age was identified as a common risk factor for both Afib and GERD, leading to the substratification of the
cohort into two age groups, using 50 years as a reference point. Other risk factors, such as obesity, smoking, hiatal hernia,
race, and gender, were accounted for using ICD10 codes, and these factors were included in the analysis. Results: The
results of the study revealed a clear predisposition for an increased risk of GERD and its related complications in younger
patients with Afib. The prevalence of GERD was significantly higher in patients with Afib compared to those without (24.9%
vs. 16.0%), with similar trends in both paroxysmal Afib (PAF) and persistent Afib (PerAF) subtypes. However, the overall risk
of developing GERD did not increase significantly in older patients with Afib. In patients under 50, the prevalence of GERD
(17.9% vs. 6.8%) and GERD phenotypes, such as nonerosive reflux disease (NERD) and erosive esophagitis (EE), was
notably higher in Afib patients than in those without Afib. Patients under 50 with PAF had higher odds of developing GERD
(1.213) and NERD (1.218) than those without Afib. Younger Afib patients also exhibited higher rates of reflux-related
complications. These included esophageal strictures (21.8 vs. 7.3 per 10,000), Barrett’s esophagus without dysplasia (32.8
vs. 8.4 per 10,000), and esophageal cancer (10.3 vs. 1.8 per 10,000), particularly in those with PAF and PerAF. Afib patients
with PAF under 50 demonstrated significantly higher odds of developing Barrett's esophagus without dysplasia (1.532),
while those with PerAF had a higher risk of esophageal cancer (1.543). Conclusion: In conclusion, Afib in patients under 50
is associated with a significantly higher risk of developing GERD and its related complications, highlighting the role of age in
disease progression.