
Stroke and gastroesophageal reflux disease (GERD) are two common medical conditions with a high incidence and a heavy health and economic burden. GERD is a digestive system disease that causes various oesophageal lesions and related complications due to the reflux of gastric contents. Stroke is a cerebrovascular disease caused by neurological deficits associated with acute focal injury to the central nervous system.
Several studies have found a link between the two conditions. A population-based cohort study found that stroke patients had a higher incidence of GERD than non-stroke subjects. Another population-based follow-up study suggests that young patients with gastric reflux oesophagitis are at higher risk of stroke. An analysis of inpatient samples also found that reflux oesophagitis increased the incidence of acute stroke in patients with atrial fibrillation.
However, the causal relationship between GERD and stroke and its subtypes has not been confirmed. To address this, a Mendelian randomisation (MR) study was conducted to evaluate the bidirectional causal relationship between stroke and its common subtypes and GERD. The results of the study provide evidence supporting a causal relationship between GERD and stroke and some of its common subtypes.
Characteristics | Values |
---|---|
Can GERD cause a stroke? | Yes |
Type of study | Population-based cohort study, Mendelian randomization study |
GERD risk in stroke patients | 1.51 times higher than in non-stroke patients |
GERD risk factors | Male sex, age 65 or older, hyperlipidemia, ischemic heart disease, renal disease, use of aspirin, clopidogrel, and dipyridamole |
Stroke risk factors | Type 2 diabetes, sleep apnea syndrome, high body mass index, high waist-to-hip ratio, and elevated serum triglyceride levels |
What You'll Learn
- GERD and stroke are linked by the brain-gut axis
- GERD may cause stroke through vagal nerve dysfunction
- Stroke may cause GERD through impaired voluntary control of oropharyngeal movements
- GERD may cause stroke through hypertension and type 2 diabetes
- Stroke may cause GERD through the use of drugs such as aspirin
GERD and stroke are linked by the brain-gut axis
The brain-gut axis is composed of neural, vascular, and even lymphatic pathways. The primarily sensory vagus nerve serves as a direct, rapid pathway through which the gut microbiota can affect brain function. CNS input influences ENS activity to affect gut microbiome composition and diversity by modulating intestinal motility, transit, barrier integrity, and secretion of factors into the lumen that influence microbial gene expression and function.
TBI induces a stress response that impacts the well-documented autonomic nervous system (ANS) control of GI function. Activation of the systemic immune system following TBI could play a major role in subsequent GI dysfunction, and the effects of TBI may be amplified further by psychological distress, which is known to exacerbate GI symptoms.
TBI-induced dysautonomia and systemic inflammation contribute to the secondary GI events, including dysmotility and increased mucosal permeability. These effects shape, and are shaped by, changes in microbiota composition and activation of resident and recruited immune cells. Microbial products and immune cell mediators, in turn, modulate brain-gut activity.
Importantly, secondary enteric inflammatory challenges prolong systemic inflammation and worsen TBI-induced neuropathology and neurobehavioural deficits.
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GERD may cause stroke through vagal nerve dysfunction
Gastroesophageal reflux disease (GERD) is a digestive system disease that causes various oesophageal lesions and related complications due to the reflux of gastric contents. It has been found that GERD can causally increase the risk of stroke, with the potential cause being related to vagal nerve dysfunction.
The vagus nerve is one of twelve cranial nerves in the body and is responsible for various bodily functions, including digestion, heart rate, and breathing. It carries signals between the brain, heart, and digestive system and is a key part of the parasympathetic nervous system, which controls specific body functions such as digestion, heart rate, and the immune system.
GERD can affect regular oesophageal transport, peristalsis, and the normal function of the lower oesophageal sphincter, leading to an increased risk of vagal nervous system dysfunction. This, in turn, can lead to impairment of the cholinergic anti-inflammatory pathway, resulting in immune system dysregulation, increased inflammatory mediators in the bloodstream, and an exaggerated immune response. The excessive inflammatory response in blood vessels and impairment of cerebrovascular autonomic flow regulation function can lead to an increased risk of strokes, particularly large vessel strokes.
Additionally, esophageal acid reflux, a common symptom of GERD, can cause oesophageal peristalsis disorder and vagus nerve damage, leading to a decrease in coronary blood flow and the induction of cardiovascular diseases such as angina, which can further increase the risk of cardiogenic stroke.
In summary, while the specific mechanism of the causal relationship between GERD and stroke requires further exploration, current evidence suggests that vagal nerve dysfunction may play a role in the increased risk of stroke among individuals with GERD.
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Stroke may cause GERD through impaired voluntary control of oropharyngeal movements
Dysphagia can also affect nutritional factors and neural centres that regulate intestinal motility and appetite, such as the sympathetic and parasympathetic medulla and hypothalamic centre. This can further increase the risk of GERD.
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GERD may cause stroke through hypertension and type 2 diabetes
A study published in the Journal of Stroke and Cerebrovascular Diseases has confirmed a credible causal link between genetically predicted GERD and stroke. The study also found that hypertension (HTN) and type 2 diabetes (T2D) mediated 36.0% and 15.8% of the effect of GERD on stroke, respectively.
Hypertension
Hypertension, or high blood pressure, is a common cardiovascular disorder in Western societies, often caused by poor diet, increased sodium intake, lack of physical activity, increased stress, psychosocial disorders, and smoking. The force of blood pushing against the artery walls is too high, making it difficult for the heart to pump blood efficiently. This condition can lead to an increased risk of heart attack, stroke, kidney failure, kidney disease, and dementia, among other health issues.
GERD and hypertension are interconnected. People diagnosed with GERD are more likely to have hypertension, and certain antihypertensive drugs, such as calcium channel blockers, can reduce the pressure of the lower esophageal sphincter (LES) and increase esophageal acid exposure time, potentially leading to GERD. On the other hand, proton pump inhibitors (PPIs), which are commonly used to treat GERD, have been found to affect nitric oxide activity, which can lead to endothelial dysfunction and potentially hypertension.
Type 2 Diabetes
Type 2 diabetes is a condition where the body does not produce enough insulin or does not use it effectively, resulting in high blood sugar levels. This can lead to various complications, including retinopathy, chronic kidney disease, limb amputation, heart disease, and stroke. People with type 2 diabetes tend to develop these complications at an earlier age than those without the condition.
The link between type 2 diabetes and stroke relates to how the body handles blood glucose. When food is digested, glucose enters the bloodstream and travels to cells throughout the body. Insulin, a hormone produced by the pancreas, is needed for glucose to enter cells and provide energy. In type 2 diabetes, either the pancreas does not produce enough insulin or the body's cells do not use insulin correctly, resulting in high blood glucose levels. Over time, this can increase fatty deposits or clots in blood vessels, which can lead to stroke.
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Stroke may cause GERD through the use of drugs such as aspirin
A stroke occurs when a blood vessel carrying oxygen and nutrients to the brain is blocked by a clot or bursts. This can cause part of the brain to be deprived of the blood and oxygen it needs, leading to brain cell death. One of the ways to prevent strokes is through the use of drugs such as aspirin, which prevents platelets from clumping and forming clots. However, aspirin therapy is not recommended for those who have never had a heart attack or stroke due to the risk of bleeding. In fact, for those over 70, taking aspirin to prevent a first heart attack or stroke could do more harm than good.
Aspirin is known to cause several complications due to its blood-thinning properties. People who take aspirin regularly are at risk of stomach problems, including stomach bleeding. Alcohol consumption can further increase these stomach risks. Additionally, those with gastrointestinal bleeding or hemorrhagic stroke should not take daily low-dose aspirin.
A study has shown that patients with cerebral stroke have an increased risk of gastroesophageal reflux disease (GERD). The risk of GERD was found to be approximately 1.51 times higher in stroke patients than in those without a stroke, after adjusting for age, sex, and the cumulative incidence of some comorbidities. Furthermore, the use of aspirin was associated with a 2.34-fold increase in GERD risk.
In conclusion, while aspirin is a well-established treatment for patients with a history of stroke, it can also be a cause of GERD. Therefore, it is important for individuals to consult with their doctors before taking aspirin to weigh the benefits against the potential risks.
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Frequently asked questions
Studies have shown that there is a causal relationship between GERD and stroke. Patients with cerebral stroke have an increased risk of developing gastroesophageal reflux disease (GERD). The risk of GERD in patients with stroke is about 1.51 times higher than in patients without stroke.
Several risk factors for stroke have been implicated in the causal relationship between GERD and stroke, including type 2 diabetes, sleep apnea syndrome, high body mass index, high waist-to-hip ratio, and elevated serum triglyceride levels.
GERD is a digestive system disease that causes various oesophageal lesions and related complications due to the reflux of gastric contents. The two most common symptoms of GERD are heartburn and regurgitation.