The contribution of gastroesophageal reflux to chest pain in patients with coronary artery disease

Area of Science:

• Cardiology
• Gastroenterology
• Diagnostic Medicine

Background:

• Refractory chest pain in patients with coronary artery disease (CAD) poses a diagnostic challenge.
• Optimal antianginal therapy often fails to alleviate symptoms in a subset of CAD patients.
• Investigating non-cardiac causes is crucial for effective management.

Purpose of the Study:

• To determine the effectiveness of investigating and treating gastroesophageal reflux disease (GERD) as a cause of refractory chest pain.
• To evaluate the utility of combined esophageal pH and Holter monitoring in identifying chest pain etiology.
• To assess the response of GERD-related chest pain to acid suppression therapy.

Main Methods:

• A cohort study was conducted at a tertiary referral center.
• 34 patients with angiographically proven CAD and persistent chest pain despite optimal therapy were included.
• Combined 24-hour esophageal pH monitoring and Holter studies were performed, followed by open-label treatment with high-dose acid suppressants for confirmed acid-related symptoms.

Main Results:

• Chest pain episodes were monitored, with 23.2% correlating with acid reflux and 3.7% with cardiac ischemia.
• Of patients with acid reflux-related chest pain, 67% showed significant improvement or resolution after 8 weeks of acid suppression therapy.
• Combined pH and Holter monitoring identified a definite cause for chest pain in 71% of patients.

Conclusions:

• Gastroesophageal reflux disease is a frequent and treatable cause of chest pain in symptomatic CAD patients.
• Combined esophageal pH and Holter monitoring are valuable complementary tools for diagnosing chest pain in this population.
• Targeted acid suppression therapy can effectively manage GERD-induced chest pain, improving patient outcomes.