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Does gastro-esophageal reflux provoke the myocardial ischemia in patients with CAD?

Slawomir Dobrzycki1, Andrzej Baniukiewicz, Janusz Korecki

  • 1Department of Invasive Cardiology, Medical University in Bialystok, Ul. Sklodowskiej 24a, 15-276 Bialystok, Poland. slawek_dobrzycki@yahoo.com

International Journal of Cardiology
|September 3, 2005
PubMed

Insights

Gastro-esophageal reflux disease (GERD) is common in patients with coronary artery disease (CAD) and can trigger myocardial ischemia. Treating GERD with proton pump inhibitors significantly reduces ischemic episodes and total ischemic burden.

Area of Science:

  • Cardiology
  • Gastroenterology

Background:

  • Gastro-esophageal reflux disease (GERD) is a potential cause of chest pain, often mimicking cardiac ischemia.
  • Patients with coronary artery disease (CAD) may also experience GERD, complicating diagnosis and treatment.
  • The relationship between GERD and myocardial ischemia in CAD patients requires further investigation.

Purpose of the Study:

  • To determine the correlation between myocardial ischemia and GERD in patients with established CAD.
  • To assess the impact of short-term anti-reflux therapy on myocardial ischemia in GERD and CAD patients.

Main Methods:

  • Fifty patients with confirmed CAD underwent 24-hour continuous ECG and esophageal pH monitoring.
  • Key metrics included ST-segment depression episodes, total ischemic burden (TIB), and esophageal pH parameters (time percentage of pH < 4, total time of pH < 4, pathological refluxes).
  • Patients meeting GERD criteria received 7-day omeprazole therapy, followed by repeat monitoring.

Main Results:

  • GERD was identified in 46% of patients, with 84% experiencing pathological refluxes.
  • A significant correlation was observed between pathological reflux events and ST-segment depression episodes (20.6%).
  • GERD patients exhibited higher TIB and more ST-segment depressions; anti-reflux therapy significantly reduced these parameters and improved pH monitoring results.

Conclusions:

  • GERD is prevalent in CAD patients and can precipitate myocardial ischemia.
  • Short-term proton pump inhibitor therapy effectively reduces myocardial ischemia in these patients.
  • This suggests an "linked angina" phenomenon, where acid reflux triggers cardiac events via an esophago-cardiac reflex.
Abstract

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