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Patients undergoing ablation for atrial fibrillation may be at increased risk of developing gastroesophageal reflux disease. We prospectively studied the presence of symptomatic gastroesophageal reflux disease in naïve patients who underwent atrial fibrillation ablation. Methods: The presence of typical symptoms suggestive of gastroesophageal reflux disease was clinically assessed by the gastroenterologist at baseline and at 3 months after ablation. In addition to that, all patients underwent upper gastrointestinal endoscopy. Results: Seventy-five patients were included in two groups: 46 patients who underwent atrial fibrillation ablation (study group) and 29 patients without ablation (control group). Patients with atrial fibrillation ablation were younger (57.76 ± 7.66 years versus 67.81 ± 8.52 years; p = 0.001), predominantly male (62.2% versus 33.3%; p = 0.030) and with higher body mass index (28.96 ± 3.12 kg/m2 versus 26.81 ± 5.19 kg/m2; p = 0.046). At three months after the ablation, in the study and control groups, there were 88.9% and 57.1% patients in sinus rhythm, respectively, (p = 0.009). Symptomatic gastroesophageal reflux disease was not more frequent in the study group (42.2% versus 61.9%; p = 0.220). There was no difference in terms of sinus rhythm prevalence in patients with versus without symptomatic gastroesophageal reflux disease (89.5% versus 88.5%; p = 0.709). Conclusion: In this small prospective study, typical symptoms suggestive of gastroesophageal reflux disease were not more frequent three months following atrial fibrillation ablation. [ABSTRACT FROM AUTHOR]

Introduction. Gastric antral vascular ectasia (GAVE) is an uncommon but often severe cause of upper gastrointestinal (GI) bleeding, responsible of about 4% of non-variceal upper GI haemorrhage. The diagnosis is mainly based on endoscopy. GAVE is characterized by a pathognomonic endoscopic pattern, mainly represented by red spots organized in stripes radially departing from pylorus, defined as watermelon stomach, or arranged in a diffused-way. Case report. We report the case of a 83 years old female patient admitted for chest pain associated with difficulty in breathing and fatigue, the symptoms subside at rest. Acute myocardial infarction was excluded but severe anemia was detected with a haemoglobin of 5.9 g/dl. The patient was known with paroxysmal atrial fibrillation controlled by amiodarone, rheumatoid arthritis for which the patient administered methotrexate, the treatment was ceased several years ago due to the reduction of disease activity. Due to CHADs-VASc score of 5, the patient was under chronic anticoagulation with DOAC. In order to identify the source of the supposed bleeding, a Upper Digestive Endoscopy was performed. The investigation revealed grade I esophageal varices without signs of recent bleeding and antral vascular ectasia. Due to local conditions, endoscopic band ligation was preferred. After the management of the anemia the patient was discharged with a haemoglobin of 9 g/dl. After a month from the EBL the patient restarted administration of DOAC which lead to a new episode of acute GI bleeding, a second session of EBL was performed with the recommendation not to administer anticoagulants until a third session which was set after 2 months. Discussion. The first line treatment is considered argon plasma coagulation (APC), given its wider availability, safety, efficacy and cost-effectiveness, though different types of endoscopic treatments are available. Given the condition of a specific patient, the physician can choose which is more appropriate for a better management. Conclusion. A patient with multiple comorbidities must have a comprehensive approach and a good understanding of bleeding versus thrombotic risks. [ABSTRACT FROM AUTHOR]