Autonomic dysfunction in gastroesophageal reflux disease. The neurogastro-cardiac axis: friend or foe?

Gastroesophageal reflux disease (GERD) is a complex and highly prevalent entity. Impaired gut-brain communication is associated with autonomic dysfunction. Modulation of the autonomic nervous system controls gastrointestinal functions. In GERD, a decrease in vagal tone (parasympathetic activity) and an increase in sympathetic activity with autonomic balance shifted towards the sympathetic system have been reported. Clinical questionnaires and non-invasive measurement of heart rate variability may be useful in patients with GERD to detect autonomic dysfunction. Restoration of parasympathetic system activity (mainly neuromodulation), with subsequent improvement of parasympathetic activity, will reduce the intensity of autonomic symptoms and GERD, improving quality of life.