The evaluation of gastro-oesophageal reflux and oesophagocardiac reflex in patients with angina-like chest pain following cardiologic investigations.
The aims of the study were to assess pathogenetic role of gastro-oesophageal reflux and the oesophago-cardiac reflex in subjects with chest pain. To evaluate the prevalence of gastro-oesophageal reflux disease and the oesophago-cardiac reflex in patients with different coronary artery diseases and in coronary spasm.


METHODS
Fifty-one patients with chest pain were enrolled after detailed cardiologic evaluation including coronary angiography. The prevalence of gastrooesophageal reflux disease was established by symptom analysis, upper gastrointestinal endoscopy, 24-h oesophageal pH monitoring, and oesophageal manometry. The oesophago-cardiac reflex was established by oesophageal acid perfusion test (0.1 N HCl and 0.9% NaCl, 120-120 ml/10 min in a blinded manner) combined with transoesophageal Doppler echocardiographic coronary flow measurement in the left anterior descending artery.


RESULTS
Gastro-oesophageal reflux disease was established in 45% (23/51) of the patients. Oesophageal acid perfusion decreased the coronary flow velocity in 49% (25/51) of the patients indicating the presence of oesophago-cardiac reflex. Oesophago-cardiac reflex was present more frequently in patients with coronary spasm, than in patients with either epicardial coronary artery disease or microvascular coronary disease (p<0.02). Patients with oesophago-cardiac reflex had higher DeMeester scores, increased number of reflux episodes, fraction time below pH 4, and prolonged acid reflux episodes (p<0.05 for each parameter).


CONCLUSIONS
Gastro-oesophageal reflux disease is frequently established in patients with either epicardial or microvascular coronary artery disease or with coronary spasm. The oesophago-cardiac reflex was more frequently observed in patients with coronary spasm. The combination of oesophageal acid perfusion test and transoesophageal Doppler echocardiographic coronary flow measurement seems to be a useful method for the detection of this reflex. Patients with prolonged gastro-oesophageal acid reflux episodes, erosive oesophagitis and coronary spasm may be at higher risk for the development of linked-angina.
Rosztóczy
András
A
First Department of Medicine, Albert Szent-Györgyi Medical, Centre, University of Szeged, Hungary. air@in1st.szote.u-szeged.hu
Vass
Andrea
A
Izbéki
Ferenc
F
Nemes
Attila
A
Rudas
László
L
Csanády
Miklós
M
Lonovics
János
J
Forster
Tamás
T
Wittmann
Tibor
T
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000787:Angina Pectoris / Q000150:complications* / Q000503:physiopathology; D002637:Chest Pain / Q000209:etiology* / Q000503:physiopathology*; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003327:Coronary Disease / Q000150:complications* / Q000503:physiopathology*; D003329:Coronary Vasospasm / Q000150:complications / Q000503:physiopathology; D004452:Echocardiography; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000503:physiopathology*; D005773:Gastroscopy; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008365:Manometry; D008875:Middle Aged