[Gastroesophageal reflux disease and coronary heart disease--coexistence or interrelationship?]

There is the normal coronary artery appearance in 20-30% of coronarographies, made in patients with chest pain and/or positive noninvasive cardiological tests. The simple explanation of this fact is the presence of diseases which may affect coronary perfusion via mechanism independent to the diameter of main coronary arteries. One of them is gastroesophageal reflux disease (GERD). The presence of GERD symptoms in general population concerns about 30-40% of individuals, while non-physiological reflux is stated in 50-65-85% of patients with coronary heart disease (CHD). That means, that GERD is twice more frequent in patients with CHD than in general population. One explanation of the increased frequency of gastroesophageal reflux appearance in patients with CHD is the adverse effect of drugs used in treatment of cardiological diseases. Morover, one of potential mechanisms explaining the influence of esophagal disturbance on the appearance of coronary hipoperfusion may be their common neurological control of the functions. There are three aspects of it: vagal reflexes (esophageal-cardiac reflex), the disturbances of autonomic nervous system balance and changes in visceral pain perception threshold. Visceral reflex can combine GERD and CHD with mechanism of vicious circle: acid gastroesophageal reflux via vagal reflex may cause coronary hipoperfusion, and the products of anaerobic metabolism of cardiomyocytes may cause relaxation of lower esophagus sphincter, facilitating reflux. Additional mechanism connecting GERD and CHD is inflammation caused by Helicobacter pylori infection. The relationship between digestive tract pathology and evolution, as well as progression and complications of atherosclerosis together with similarity of clinical presentation imply the necessity of precise diagnosis of chest pain causes and caution in interpretation of laboratory examination results.