Does gastro-esophageal reflux provoke the myocardial ischemia in patients with CAD?
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".
Dobrzycki
Slawomir
S
Department of Invasive Cardiology, Medical University in Bialystok, Ul. Sklodowskiej 24a, 15-276 Bialystok, Poland. slawek_dobrzycki@yahoo.com
Baniukiewicz
Andrzej
A
Korecki
Janusz
J
Bachórzewska-Gajewska
Hanna
H
Prokopczuk
Przemyslaw
P
Musial
Włodzimierz J
WJ
Kamiński
Karol A
KA
Dabrowski
Andrzej
A
D000328:Adult; D000368:Aged; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D002940:Circadian Rhythm / Q000187:drug effects; D003324:Coronary Artery Disease / Q000150:complications* / Q000503:physiopathology; D015716:Electrocardiography, Ambulatory; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D006801:Humans; D006863:Hydrogen-Ion Concentration / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D017202:Myocardial Ischemia / Q000209:etiology* / Q000503:physiopathology; D009853:Omeprazole / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome
D000897:Anti-Ulcer Agents; D009853:Omeprazole