title: Gastroesophageal reflux in patients with angiographically normal coronary arteries: an uncommon cause of exertional chest pain.
abstract: OBJECTIVE
  To investigate the association between exertional chest pain and gastroesophageal reflux in patients with normal coronary angiograms and in controls by measuring oesophageal pH during treadmill exercise tests and to compare the results with routine ambulatory monitoring.
  
  
  METHODS
  Case control study.
  
  
  METHODS
  Tertiary referral cardiac unit.
  
  
  METHODS
  50 consecutive patients with chest pain and completely normal coronary angiograms and 16 controls with coronary artery stenoses.
  
  
  METHODS
  Episodes of acid reflux and chest pain during treadmill exercise; a symptom index expressing the percentage of episodes of pain related to acid reflux during ambulatory monitoring.
  
  
  RESULTS
  Four (8%) patients and two (12%) controls had reflux during treadmill exercise (NS). 32 (64%) and 16 (100%) reported chest pain, but only three (6%) and two (12%) had coincident reflux (NS). Reflux was as frequent before, during, and after treadmill exercise (five (8%) v six (9%) v two (3%)) in the 66 subjects; (NS). 19 (38%) patients and three (19%) controls had abnormal reflux on ambulatory monitoring (NS). Eight (16%) and three (19%) had a symptom index > 50%, but six and two of these reported pain without coincident reflux during treadmill exercise.
  
  
  CONCLUSIONS
  There are many potential causes of chest pain in patients with angiographically normal coronary arteries. Although gastroesophageal reflux is commonly implicated and many patients have a high incidence of spontaneous reflux during ambulatory monitoring, it rarely occurs during exertion and the association with chest pain is poor.
authors.affiliation: Department of Cardiology, Guy's Hospital, London.
authors.forename: R A
authors.initials: RA
authors.lastname: Cooke
authors.forename: A
authors.initials: A
authors.lastname: Anggiansah
authors.forename: N C
authors.initials: NC
authors.lastname: Smeeton
authors.forename: W J
authors.initials: WJ
authors.lastname: Owen
authors.forename: J B
authors.initials: JB
authors.lastname: Chambers
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002637:Chest Pain / Q000209:etiology*; D017023:Coronary Angiography; D003327:Coronary Disease / Q000503:physiopathology; D005080:Exercise Test; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic