Rosztóczy A, Vass A, Izbéki F, Nemes A, Rudas L, Csanády M, Lonovics J, Forster T, Wittmann T. The evaluation of gastro-oesophageal reflux and oesophagocardiac reflex in patients with angina-like chest pain following cardiologic investigations.
Int J Cardiol 2007;
118:62-8. [PMID:
16891012 DOI:
10.1016/j.ijcard.2006.05.035]
[Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2006] [Accepted: 05/27/2006] [Indexed: 11/29/2022]
Abstract
UNLABELLED
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.
PATIENTS, 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.
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