Gastro-Cardiology: A Novel Perspective for the Gastrocardiac Syndrome

Abstract

The gastrocardiac syndrome was coined originally at the beginning of the 19^th century to describe an alleged gastric-cardiopathy with reflux heartburn mimicking cardiac chest pain. Today, a wider perspective of gastrocardiac syndrome has emerged. First, the cardiovascular risk factor chronic systemic inflammation may reflect gastroenterological inflammatory conditions, such as inflammatory bowel disease and gastrointestinal infections, in particular, chronic Helicobacter pylori infection. Furthermore, since contemporary treatment of cardiovascular disease commonly includes potent antithrombotic medications, the cardiovascular benefit in terms of a decrease in the incidence of recurrent ischemic events and death needs to be carefully balanced with an increased risk of gastrointestinal bleeding. Several strategies to target chronic gastrointestinal inflammation and to diagnose and treat Helicobacter pylori to reduce the risk of cardiovascular events and gastrointestinal bleeding are available but residual controversy remains and large-scale gastro-cardiology trials are needed to determine the optimal treatment approaches. In perspective, the centennial gastrocardiac syndrome is more relevant than ever in a contemporary gastroenterology and cardiology setting. A collaborative subspecialty, namely Gastro-cardiology, would introduce novel unique means to study, diagnose and treat gastrocardiac conditions with the aim to reduce the risk of cardiovascular and bleeding events to improve the prognosis for gastro-cardiology patients.

Keywords: Helicobacter pylori; atherosclerosis; cardiovascular disease; gastrocardiac syndrome; mortality; myocardial infarction; stroke; upper gastrointestinal (GI) bleeding.

Figure 1

Gastrocardiac syndrome. Depending on host health including socioeconomic status (SES) and virulence factors, Helicobacter pylori affects the gastric mucosa causing gastroduodenal lesions with the risk to develop bleeding complications. Simultaneously, it induces chronic inflammation to the vascular wall affecting progress and degree of cardiovascular disease such as stroke, myocardial infarction (MI), atrial fibrillation (AF) and valvular heart disease. Cardiovascular diseases are commonly treated with antithrombotic drugs, which aggravate the risk of upper gastrointestinal bleeding.