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Does gastro-esophageal reflux provoke the myocardial ischemia in patients with CAD?
Int J Cardiol. 2005 Sep 15; 104(1):67-72.IJ

Abstract

BACKGROUND

Gastro-esophageal reflux disease (GERD) may cause chest pain. The aim was to determine the correlation between ischemia and gastro-esophageal reflux in patients with CAD and to assess the influence of short-term "anti-reflux" therapy on the ischemia in patients with GERD and CAD.

METHODS

Fifty patients with angiographically proven CAD underwent simultaneous 24-h continuous ECG and esophageal pH monitoring. We assessed the number of ST-segment depression episodes (ST dep.) and total duration of ischemic episodes, expressed as total ischemic burden (TIB). In pH-metry, we assessed: time percentage of pH lower than 4, total time of pH lower than 4 and the number of pathological refluxes (PR). Patients fulfilling the GERD criteria received a 7-day therapy with omeprazole 20 mg bid. On the 7th day of therapy, simultaneous Holter and esophageal pH monitoring was repeated.

RESULTS

Total number of 224 PRs in 42 patients (84%) was recorded during esophageal pH-metry. GERD criteria were fulfilled in 23 patients (46%). Out of 218 episodes of ST dep., 45 (20.6%) correlated with PR. GERD patients had larger TIB and higher number of ST dep. (p<0.015 and p<0.035, respectively). The anti-reflux therapy reduced all analyzed parameters of esophageal pH monitoring (p<0.0022) as well as the number of ST dep. (p<0.012) and TIB (p<0.05).

CONCLUSIONS

Gastro-esophageal reflux disease is common in patients with CAD and may provoke myocardial ischemia. Short-term proton pump inhibitors therapy that restores normal esophageal pH significantly reduces myocardial ischemia, possibly due to elimination of acid-derived esophago-cardiac reflex compromising coronary perfusion-the phenomenon known as "linked angina".

Authors+Show Affiliations

Department of Invasive Cardiology, Medical University in Bialystok, Ul. Sklodowskiej 24a, 15-276 Bialystok, Poland. slawek_dobrzycki@yahoo.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16137512

Citation

Dobrzycki, Slawomir, et al. "Does Gastro-esophageal Reflux Provoke the Myocardial Ischemia in Patients With CAD?" International Journal of Cardiology, vol. 104, no. 1, 2005, pp. 67-72.
Dobrzycki S, Baniukiewicz A, Korecki J, et al. Does gastro-esophageal reflux provoke the myocardial ischemia in patients with CAD? Int J Cardiol. 2005;104(1):67-72.
Dobrzycki, S., Baniukiewicz, A., Korecki, J., Bachórzewska-Gajewska, H., Prokopczuk, P., Musial, W. J., Kamiński, K. A., & Dabrowski, A. (2005). Does gastro-esophageal reflux provoke the myocardial ischemia in patients with CAD? International Journal of Cardiology, 104(1), 67-72.
Dobrzycki S, et al. Does Gastro-esophageal Reflux Provoke the Myocardial Ischemia in Patients With CAD. Int J Cardiol. 2005 Sep 15;104(1):67-72. PubMed PMID: 16137512.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Does gastro-esophageal reflux provoke the myocardial ischemia in patients with CAD? AU - Dobrzycki,Slawomir, AU - Baniukiewicz,Andrzej, AU - Korecki,Janusz, AU - Bachórzewska-Gajewska,Hanna, AU - Prokopczuk,Przemyslaw, AU - Musial,Włodzimierz J, AU - Kamiński,Karol A, AU - Dabrowski,Andrzej, PY - 2004/04/20/received PY - 2004/09/10/revised PY - 2004/10/04/accepted PY - 2005/9/3/pubmed PY - 2006/8/9/medline PY - 2005/9/3/entrez SP - 67 EP - 72 JF - International journal of cardiology JO - Int. J. Cardiol. VL - 104 IS - 1 N2 - BACKGROUND: Gastro-esophageal reflux disease (GERD) may cause chest pain. The aim was to determine the correlation between ischemia and gastro-esophageal reflux in patients with CAD and to assess the influence of short-term "anti-reflux" therapy on the ischemia in patients with GERD and CAD. METHODS: Fifty patients with angiographically proven CAD underwent simultaneous 24-h continuous ECG and esophageal pH monitoring. We assessed the number of ST-segment depression episodes (ST dep.) and total duration of ischemic episodes, expressed as total ischemic burden (TIB). In pH-metry, we assessed: time percentage of pH lower than 4, total time of pH lower than 4 and the number of pathological refluxes (PR). Patients fulfilling the GERD criteria received a 7-day therapy with omeprazole 20 mg bid. On the 7th day of therapy, simultaneous Holter and esophageal pH monitoring was repeated. RESULTS: Total number of 224 PRs in 42 patients (84%) was recorded during esophageal pH-metry. GERD criteria were fulfilled in 23 patients (46%). Out of 218 episodes of ST dep., 45 (20.6%) correlated with PR. GERD patients had larger TIB and higher number of ST dep. (p<0.015 and p<0.035, respectively). The anti-reflux therapy reduced all analyzed parameters of esophageal pH monitoring (p<0.0022) as well as the number of ST dep. (p<0.012) and TIB (p<0.05). CONCLUSIONS: Gastro-esophageal reflux disease is common in patients with CAD and may provoke myocardial ischemia. Short-term proton pump inhibitors therapy that restores normal esophageal pH significantly reduces myocardial ischemia, possibly due to elimination of acid-derived esophago-cardiac reflex compromising coronary perfusion-the phenomenon known as "linked angina". SN - 0167-5273 UR - https://www.unboundmedicine.com/medline/citation/16137512/Does_gastro_esophageal_reflux_provoke_the_myocardial_ischemia_in_patients_with_CAD L2 - https://linkinghub.elsevier.com/retrieve/pii/S0167-5273(05)00139-7 DB - PRIME DP - Unbound Medicine ER -