Digestive Disorders > Upper Abdomen

Roemheld syndrome

Dr. med. Andre Sommer

Dr. med. Andre Sommer

Roemheld syndrome describes a group of symptoms that are triggered by excessive gas accumulation in the gastrointestinal tract. This syndrome mainly concerns heart complaints, especially chest tightness and chest pain. How do these symptoms occur? What diagnostic options are there? What are the causes? And how can you treat Roemheld syndrome?

What is Roemheld syndrome?

Roemheld syndrome is also considered by medical professionals to be a gastro cardiac syndrome or gastro heart syndrome. The term “syndrome” does not describe an independent disease, but is used to summarize a group of symptoms that occur under one generic term. Roemheld syndrome primarily concerns discomfort of the chest and heart, the trigger of which can be found in the gastrointestinal tract. The doctor Ludwig von Roemheld first described this syndrome in the early 20th century, which is why it still bears his name today.

What are the symptoms of Roemheld syndrome?

A variety of symptoms can occur as part of Roemheld syndrome. The most important include a number of heart problems that resemble the symptoms of angina pectoris (chest tightness). This leads to heartburn-like pain that mainly occurs behind the breastbone. In addition, patients describe tightness in the area of the heart as if constant pressure is being exerted on the heart. In real angina pectoris, which is mainly caused by changes in the coronary arteries, the pain often radiates to the left arm, the shoulders and the lower jaw. With the pain that occurs in the context of Roemheld syndrome, such a radiation can also occur, but is less common.

Other symptoms of Roemheld syndrome include hot flashes, shortness of breath, anxiety, vertigo and difficulty in breathing.

How do the symptoms of Roemheld syndrome develop?

When Ludwig von Roemheld described the syndrome for the first time, he noticed that the cause was not found in the heart for any of the patients.

The cause of the symptoms was in thegastrointestinal tract. The main cause for the development of the symptoms was excessive accumulation of gases in the stomach and intestines. However, anatomical diseases, such as the stomach sliding through the diaphragmatic opening towards the esophagus (hiatal hernia) also lead to symptoms associated with Roemheld syndrome.

The increased volume of the gastrointestinal tract leads to displacement of the diaphragm towards the chest cavity. When healthy, the diaphragm, which lies under the lungs and is the most important component of the respiratory muscles, provides a natural partition wall between the chest cavity and the abdominal cavity. If it is displaced in the direction of the chest cavity, the space that the lungs and heart have to constrict at the same time is reduced. The heart can no longer beat regularly, which leads to the typical cardiac symptoms. The lungs can no longer develop fully either, causing difficulty in breathing and shortness of breath.

Symptom Cause
Heart problems The pressure on the diaphragm causes the heart to be constricted in its cavity in the chest (mediastinum) and therefore cannot develop its full pumping power
Shortness of breath The high position of the diaphragm puts pressure on the lungs. The diaphragm can contract less so it is harder to breathe
Hot flashes Impaired cardiac function leads to activation of the autonomic nervous system, the so-called sympathetic nervous system, which is responsible for the so-called “fight or flight” reaction. One consequence of this sympathetic activation is the feeling of hot flashes
Anxiety Activation of the autonomic nervous system and the feeling of pain in the heart area often trigger acute anxiety

Tab.1: Symptoms of Roemheld syndrome and their causes

How is the increased gas accumulation in the gastrointestinal tract triggered?

Intestinal gases arise mainly from the fact that food components are digested by the bacteria found in the intestine (intestinal flora). As a by-product or end product of this process, gases such as methane, carbon dioxide or hydrogen sulfide are released. Diseases that lead to an increased production of intestinal gases can trigger Roemheld syndrome. Likewise, diseases that prevent the escape of intestinal gases or in other ways displace the diaphragm towards the abdominal cavity can be a cause.

  • Food intolerances

Food intolerance is often associated with increased gas production by intestinal bacteria. Important examples include lactose intolerance and gluten intolerance (celiac disease). Since the body cannot absorb milk sugar in the case of lactose intolerance, it is increasingly converted by the bacteria in the intestinal flora. Intestinal gases are produced as breakdown products, which can lead to flatulence (meteorism) and gas (winds). If the gases do not escape completely or accumulate in the gastrointestinal tract, symptoms associated with Roemheld syndrome can result.

  • Inflammation of the gastrointestinal tract

If there is an inflammation of the stomach (gastritis) or inflammation of the entire gastrointestinal tract (gastroenteritis), digestive gases may also be produced more frequently in the intestine. The accumulation of gases in turn leads to the appearance of Roemheld syndrome.

  • Hiatal hernias

The term hiatal hernia describes the relocation of part of the stomach from the abdominal to the chest cavity. The diaphragm has an opening through which the esophagus can reach from the chest cavity into the abdominal cavity and thus into the stomach (Hiatus oesophagus). It can happen that part of the stomach slips through this opening and is thus moved into the chest cavity. Here, like intestinal gases, this can lead to displacement of the diaphragm which can trigger Roemheld syndrome.

  • Irritable bowel syndrome

Patients with irritable bowel syndrome are also at higher risk of developing Roemheld syndrome. Since irritable bowel syndrome is a complex disease that includes various triggers and influencing factors, it is particularly difficult to pinpoint the exact cause of the occurrence of Roemheld syndrome. However, an increased accumulation of gases in the gastrointestinal tract is also responsible for Roemheld symptoms in irritable bowel patients.

Also very sumptuous and fatty meals can, in rare cases, lead to Roemheld syndrome.

Certain impairments in digestive health can be successfully treated as part of a nutritional therapy program. We have developed a nutritional therapy program that is tailored to your symptoms with your personal nutritionist. Learn more about therapy here and arrange a free initial consultation.

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How does a doctor diagnose Roemheld syndrome?

Roemheld syndrome is a so-called diagnosis of exclusion. This means that if a Roemheld syndrome is suspected, the doctor will try to rule out possible diseases of the heart. As soon as he has made sure that the symptoms are not caused by a heart disease, he can diagnose Roemheld syndrome.

In order to rule out heart diseases, in addition to a detailed survey of the person concerned (anamnese) a heart monitor is used. In addition, the patient receives an electrocardiogram (EKG) to assess the activity of the heart. If necessary, the attending doctor also does an ultrasound of the heart (echocardiography) or uses other imaging methods (computed tomography: CT, magnetic resonance imaging: MRI).

How can Roemheld syndrome be treated?

The treatment of Roemheld syndrome symptoms is directed at the trigger. If a food intolerance is the cause of the increased gas production, a change of diet can bring relief from symptoms. It is recommended to use a food diary to determine the meals after which the symptoms appear. In this way the exact trigger can be identified and avoided. This process should be supported by trained experts. We have developed a nutritional therapy program, with your personal nutritionist, which is tailored to your symptoms. We also provide a digital nutrition diary to help you track your daily diet and symptoms. Learn more about therapy here and arrange a free initial consultation.

If the symptoms are caused by inflammation of the gastrointestinal tract, usually the inflammation subsides, which improves the symptoms. Because of many inflammations in the gastrointestinal tract are caused by viruses, antibiotics do not help. Antibiotics are also not used for most gastrointestinal infections caused by bacteria.

A hiatal hernia that causes discomfort can be corrected with surgery. In most cases, this leads to a reduction in symptoms.

Diet for Roemheld syndrome

If Roemheld syndrome occurs as part of irritable bowel syndrome, treatment is more difficult. That’s because the exact triggers of irritable bowel syndrome are often not fully known and are therefore difficult to treat. Again, it's worth keeping a food diary to get information about the triggering food components. Many patients also report that home remedies such as anise, fennel and caraway tea or swollen psyllium husks can help remove excess air in the intestine and relieve discomfort. More can be found on this in the article on Irritable Bowel Medication.

Medicines for Roemheld syndrome

In severe cases, the doctor can prescribe the medications dimethicone or simethicone (e.g. Sab Simplex), depending on which symptoms are in the foreground.

Dimeticon works as a defoaming agent and is used for the therapy for gas accumulations in the gastrointestinal tract. Dimeticon should be prescribed to patients who initially experience flatulence leading to Roemheld symptoms.

Simeticon works similarly to dimeticon, but it also helps against bloating and is therefore mainly used in patients who suffer from this symptom.

Conclusion:

In summary, Roemheld syndrome is an extreme burden for those affected, because chest pain and shortness of breath are mainly associated with heart attacks. However, if heart diseases can be ruled out, there are ways to treat Roemheld syndrome and to alleviate the symptoms.

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Dr. med. Andre Sommer

Dr. med. Andre Sommer

I’m André, a medical doctor from Berlin. Together with a team of medical doctors, nutritionists and data scientists we empower people to understand digestive issues with our app Cara Care.

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