Association between rosacea and gastroesophageal reflux disease

Abstract

 Rosacea and gastroesophageal reflux disease (GERD) are chronic inflammatory disorders of the skin and esophagus, which are interfaces between the environment and the human body. It is estimated that approximately 20% of the adult population suffers from GERD and only 10% from Rosacea and the prevalence of these two diseases in the same patient is less than 2%. The relationship between these two became more pronounced in patients with this comorbidity, because of long-term treatment with proton pump inhibitors (PPIs) and H2 - histamine receptor antagonists, in which a significant improvement in the symptoms of both diseases was observed. The aim was to evaluate a possible association between rosacea and gastroesophageal reflux disease. Materials and methods The study was conducted by searching English-language articles, combining the term „rosacea” with the term „gastroesophageal reflux disease” as keywords, which were published in the period 2018-2024, using PubMed, NCIB, Medscape, and Mendeley databases. Results The search identified 4 studies that demonstrated a significant association between Rosacea and GERD. This association is known to be based on the chronic inflammatory response in the skin in response to the aggression of the Demodex folliculorum mite and in the esophagus in response to hydrochloric acid injury. Therefore, inflammation evolves with the subsequent occurrence of endothelial dysfunction, which results in the destruction of barriers, loss of elasticity of the vascular wall, impaired microcirculation, disorders of nervous and trophic integration with defective tissue regeneration. The persistence of inflammatory mediators such as histamine, mast cells, prostaglandins, prostacyclin, thromboxanes, leukotrienes, interleukins-1, -6, TNF-a and T- and B-lymphocytes is another mechanism for the development and persistence of the symptoms of both diseases. They are involved in the remodeling (hyperplasia and hypertrophy) of skin tissue with disease progression from erythemato-telangiectasia rosacea to phymatous rosacea and the replacement of esophageal tissue with intestinal tissue and the development of Barrett’s esophagus. The body’s microbiome may also be a factor in the link between rosacea and other barrier tissue diseases such as those of the gastrointestinal tract. Genetic predisposition, climatic, food, and psychological factors also play an important role in the etiopathogenesis of diseases. The etiopathogenesis of the diseases is complex and is not fully elucidated, therefore, further exhaustive studies are necessary to be able to prevent or stop their development. Discussions Both pathologies have many common characteristics: age between 30-50 years, the factors incriminated in triggering the diseases are food factors such as spicy, hot foods, alcohol and smoking, both conditions are chronic and involve the interaction of genetic and inflammatory factors, and in the evolution of the diseases observing- there are periods of remission that alternate with periods of symptomatology exacerbation. The treatment of these two nosologies is complex and different, having different directions, but considering the role of histamine as an incriminating factor in maintaining the corneal inflammatory response of these diseases, the administration of antisecretory preparations in patients with this comorbidity is argued. Conclusions The recognition of the association of these two diseases by medical specialists could provide methods of care and treatment of the cause, to mitigate the exacerbating factors and relieve the symptoms of both conditions.