Select Page

Roemheld Syndrome, What is it and How to Find Relief

Roemheld syndrome (gastric-cardia syndrome) is personal for me. I know the condition exists even with the little information out there provided to us about it. I suffered from it, and it caused me to have poor heart health for a time and arrhythmia.

I believe that the syndrome exists strongly because I suffered from the syndrome after my son Abel died and it was hell.

My son Abel had passed away a month before I felt the dreaded symptoms of gastric cardia syndrome. My silent reflux had come back in spades from all the stress. All of a sudden if I overate my heart rate would dip, then shoot up to 150+ bpm. My blood pressure would also go sky high. Why is this happening to me? I started to notice some patterns over time. When I drank water, and when I burped, I felt better. When I took magnesium or had a bowel movement, I felt better. When I slowed my breathing and ate less, I also felt better. I did not know about the gastric-cardia syndrome at the time, but I went on a restrictive low-FODMAP, Dropping Acid diet. Both of the diets reduced bloating and upper gut inflammation which relieved my symptoms. In a few months I lost weight and got my digestion under control, the symptoms disappeared.

Roemheld syndrome is well known in Germany, but not much of it is known outside of Europe. I hope I can spread awareness about this cruel, debilitating disease.

What Is Roemheld Syndrome and How Serious Is It for Your Heart Health?

Roemheld syndrome is also known as gastric-cardia syndrome and was discovered by the German medical internist Ludwig Roemheld in the 1930’s. Simply put it is a condition where poor upper gut health leads to cardiac symptoms and issues. Ever felt a very low or very high heart rate during or after eating that was relieved by burping? Ever felt your heart skip multiple beats or have chest pain and trouble after eating a large meal? You probably suffer from gastric-cardia syndrome.

Most of the following symptoms of the syndrome seem to occur after eating, mainly if you consumed a large meal. Some people have also reported their symptoms to occur after strenuous activity, when excessive pressure is applied to their abdomen, or when awoken with dyspepsia during the night.

Here are the proposed symptoms or consequences of Roemheld syndrome:

  • Sinus bradycardia (less than sixty beats a minute)
  • Sinus tachycardia (greater than one hundred beats per minute)
  • Hypotension
  • Hypertension
  • An abnormal amount of premature ventricular contractions (PVC’s)
  • Arrhythmia (heart palpitations)
  • Atrial fibrillation
  • Development or worsening of heart disease
  • Sudden cardiac death
  • Poor perfusion
  • Chest pain (angina pectoris)
  • Anxiety
  • Syncope
  • GERD (gastroesophageal reflux disease), silent reflux, bile reflux, or endotoxin reflux symptoms
  • Poor sleep quality and frequent wakening
  • Fatigue
  • Weakness
  • Muscle spasms (fasciculations)
  • Muscle cramps
  • Coughing and throat clearing
  • Trouble breathing
  • Tinnitus
  • Hot flashes
  • Facial flushing
  • Vertigo
  • Visual snow

If you are showing symptoms of Roemheld syndrome your healthcare professional will run tests to determine your cardiovascular health and if you are having gastrointestinal issues, run tests to determine the possible origin as well. A cardiologist might run the following tests to assess your heart health including an electrocardiogram, 24 hour Holter monitor, cardiac scan (MRI or CT), echocardiogram, and blood work. If your heart appears to be healthy, you might be referred to a gastroenterologist if you are also suffering from gastrointestinal issues. A gastroenterologist might run a few tests as well to determine your gastrointestinal symptoms including an abdominal ultrasound, abdominal scans (CT, X-ray, MRI), and an endoscopy procedure. Most of the time the only issues found by the gastroenterologist is reflux or a hiatal hernia.

Roemheld syndrome has a few mechanical triggers. The primary mechanical trigger occurs when excessive pressure is placed on the fundus of the stomach, moving in upward displacing its anatomical position. With increased epigastric pressure the diaphragm’s position elevates and puts pressure on the heart, lungs, and vagus nerve. Hiatal hernia’s are known to be a significant mechanical trigger of the syndrome and shift part of the stomach upward putting pressure on the diaphragm. Finally, adhesion’s, anatomical surgical modifications, and meshes from gastrointestinal surgeries (including gastric bypass, hernia repair, and anti-reflux surgeries) may also displace the organs in the epigastric region which can also trigger gastric cardia syndrome.

Hiatus hernia is associated with increased occurrence of GERD symptoms. Whether the presence of hiatus hernia further increase the risk of AF is unknown. A hiatus hernia as well as an intrathoracic stomach, representing the end stage of a hiatal hernial diaphragm, has the potential to mechanically irritate the left atrium. Additionally, the hernia may increase reflux and, thereby, result in oesophagitis accompanied by AF. The association between hiatus hernia and atrial tachyarrhythmias has been described as increases in atrial ectopic beats upon swallowing in a patient with a big hiatus hernia. Interestingly, there are case reports that repair of a large paraoesophageal hernia or an intrathoracic stomach can suppress paroxysmal atrial arrhythmias.1

Another mechanical trigger of the syndrome is increased pressure put on the vagus nerve. In addition, if someone is suffering from esophageal reflux, inflammation associated with that can further cause pressure and vagal nerve irritation. When excessive force is placed on the vagus nerve, heart rate and blood pressure may widely fluctuate. When your heart rate and blood pressure drop the body’s autonomic nervous system is activated by a catecholamine dump into the bloodstream to increase it. The increased circulating catecholamines cause a massive increase in blood pressure and heart rate for some people. Unless an underlying arrhythmia is triggered, the fluctuation from low to high cardiac pulses and pressure may be undetectable unless you are actively monitored during an attack and can be easily mistaken as anxiety. When an attack occurs, strong coronary reflexes happen, causing a lot of the cardiac symptoms associated with the syndrome and if the heart is stressed enough a heart attack or atrial fibrillation may occur!

Neural reflex arcs from the oesophagus and the heart have been shown in both animals and humans. In humans, chemical, electrical, and mechanical stimulation of the oesophagus modifies the sympathovagal balance. Oesophageal stimulation amplifies respiratory-driven cardiac vagoafferent modulation, while decreasing sympathetic modulation. Oesophageal acid stimulation is further associated with an increase in vagal activity.Acid refluxes cause a local inflammatory process that may directly alter the autonomic innervations of the oesophageal mucosa and may also penetrate the oesophageal wall and stimulate the adjacent vagal nerves. Injury of the distal oesophagus can further impair vagal nerve responses, particularly nerve sensitization of the afferent pathways. These and other considerations suggest the involvement of the cardio-oesophageal reflex in case of GERD associated AF.

Several observations support the relevant role of the autonomic nervous system for the initiation and the maintenance of AF. Studies in lone AF patients and in animal models of intermittent rapid atrial pacing and congestive heart failure have indicated that AF onset is associated with simultaneous sympathovagal activation rather than with an increase in vagal or sympathetic drive alone. On the cellular level, cholinergic muscarinergic receptors are the primary mediators of parasympathetic control of heart function. Muscarin-2 receptor (M2R) stimulation with acetylcholine directly activates G-protein-dependent potassium currents leading to a shortening of the atrial action potential duration and atrial effective refractory period.34 Additionally, the effect of vagal stimulation on atrial refractoriness is heterogeneous because of heterogeneity in the distribution of parasympathetic nerve endings and/or M2Rs. Increased vagal activation, as present in GERD-patients, creates an arrhythmogenic substrate for re-entry and, thereby, increases AF-susceptibility.2

Excessive gas and bloating from dysbiotic flora in the small intestine and upper gut increases epigastric pressure, leading to the stomach moving upward triggering the gastric cardiac syndrome. Hydrogen, methane, and hydrogen sulfide production from fermentation by dysbiotic flora increases bloating especially if one ingests a diet high in FODMAP’s (fermentable oligo-, di-, monosaccharides and polyols). Finally, obesity can also play a role in triggering Roemheld syndrome by increasing both the risk for developing a hiatal hernia and cardiac issues.

There is a 3–8% higher risk of new AF-onset with each unit increase in body mass index, and this association is independent of other cardiovascular risk factors. Pericardial fat is associated with the occurrence of AF, persistence of AF, left-atrial enlargement, and worse outcomes of AF ablation.44 Additionally, obesity results in progressive atrial structural and electrical remodelling. In sheep, following a high-calorie diet, obesity was associated with atrial electro-structural remodelling, increased atrial size, changes in conduction, and more persistent AF episodes. Obesity was associated with reduced posterior left-atrial endocardial voltage and infiltration of contiguous posterior left-atrial muscle by epicardial fat. Whether the anatomical proximity of the posterior wall of the left atrium and the oesophagus play a role for the development of this potential substrate for AF is unknown. In obese patients, risk factor management according to American Heart Association/American College of Cardiology guidelines improved the long-term success of AF ablation.3

Over time the syndrome can lead to a weakening of the cardiovascular system that might lead to cardiomyopathy and congestive heart failure. It can cause an arrhythmia to develop including arrhythmia that is mostly benign including sinus tachycardia to severe as atrial fibrillation. The syndrome in people may cause heart disease and eventually heart failure.

Roemheld Syndrome Pathology

Reference: https://academic.oup.com/europace/article/19/1/16/2952312

Causes of Roemheld Syndrome Include:

  • Hiatal hernia
  • Weakened LES (lower esophageal sphincter)
  • Abdominal hernia and repair (mesh)
  • Excessive bloating and abdominal distension (SIBO, lactose intolerance, fructose intolerance, food intolerance, upper gut dysbiosis)
  • Gas bloat syndrome (failure to burp)
  • Gastric bypass surgery complications
  • Poor liver, gallbladder, and pancreatic health
  • Being overweight or obese
  • LES strengthening surgery complications (Nissen fundoplication, TIF, LYNX)

What Can Be Done to Help Recover From Roemheld Syndrome

Here are some tips to help reduce your syndrome issues and improve your health:

  • If a hiatal hernia causes your gastric-cardia syndrome, try to work on getting your stomach to remain in a correct anatomical position.
  • Reduce stomach and intestinal tract boating. If symptoms are severe, you might want to try a FODMAP diet to reduce fermentation and bloating. Some people might need to reduce protein consumption to fifty grams it bloats you as well. Relieve SIBO or upper gut dysbiosis if you are suffering from it. Taking activated charcoal may reduce bloating from absorbing excess gas. Taking digestive enzymes may help reduce gas formation. Make sure your stomach acid pH is optimal as well.
  • Relieve constipation. Constipation can increase abdominal pressure which can push the stomach upward causing Roemheld syndrome.
  • Chew your food thoroughly and eat slowly. Do not overeat when you are full.
  • Try not to consume more than four to six ounces of a beverage at meals to help prevent bloating. Consume a majority of your beverages a few hours after a meal when your stomach is emptier.
  • If you are suffering from gastroparesis, try to improve your stomach emptying if possible. Consuming ginger tea or taking one New Chapter Ginger Force after a meal may help enhance stomach emptying. Improving vagal tone might improve gastroparesis as well.
  • If you need to burp, make yourself by swallowing a little bit of water and try to make yourself burp. Most of the time burping relieves the symptoms of Roemheld syndrome.
  • Exercise regularly to strengthen your heart and supplement with magnesium and maintain proper intake of dietary omega 3 fatty acids to help reduce chances of developing severe heart arrhythmia.
  • Try to sleep on your back or side at all times if possible. Some people have fewer symptoms of Roemheld syndrome sleeping on their left or right side. Laying on the right or left side during an attack may provide instant relief. For most people laying on the right side seems to help more, even if that is counterproductive to sleeping recommendations individuals who have GERD.
  • Strengthen your diaphragm and improve your breathing!
  • Strengthen your LES and UES (upper esophageal sphincter) tone if they are weak. Most people suffering from GERD have weak LES tone, and most people suffering from silent reflux have weak LES and UES tone.
  • Try your best to lose weight if you are overweight to reduce increased abdominal pressure from excessive fat tissue and to improve cardiovascular health.

Limited Roemheld Syndrome Resources

Information is limited on gastric-cardia syndrome so please if you find any relevant studies or books pertaining to the condition, leave a comment below. Thank you.

Book:

Websites:

Podcast:

Studies:

Facebook Support Group: