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Esophageal contribution to chest pain in patients with coronary artery disease
J Garcia-Pulido1, P H Patel, W C Hunter
1Veterans Administration Medical Center, Johnson City, Tenn.
Insights
In patients with coronary artery disease (CAD), esophageal disorders, particularly gastroesophageal reflux (GER), frequently contribute to chest pain. Esophageal testing is safe and reveals motility issues in these individuals.
Area of Science:
- Cardiology
- Gastroenterology
- Clinical Medicine
Background:
- Chest pain is a common symptom in patients with established coronary artery disease (CAD).
- Differentiating cardiac from non-cardiac causes of chest pain is crucial for effective management.
- The role of esophageal dysfunction in chest pain among CAD patients requires further elucidation.
Purpose of the Study:
- To investigate the contribution of esophageal disorders to chest pain in male patients with established CAD on optimal medical therapy.
- To assess the prevalence and characteristics of esophageal acid reflux and motility abnormalities in this patient cohort.
Main Methods:
- Prospective study involving 32 men with documented CAD and frequent chest pain.
- Standard esophageal manometry and acid perfusion tests were performed.
- Simultaneous 24-hour ambulatory esophageal pH monitoring and Holter ECG monitoring were conducted.
Main Results:
- Of 20 symptomatic patients, 17 (85%) experienced proximal esophageal reflux (PPR) associated with chest pain (70% correlation).
- Ischemic ECG changes correlated with chest pain in only 13% of episodes.
- Esophageal motility abnormalities were observed in 14 patients (45%).
Conclusions:
- Esophageal disorders, especially GER, significantly contribute to chest pain in patients with documented CAD.
- GER plays a more prominent role in CAD patients compared to those without coronary artery disease.
- Esophageal motility disorders are common in this population, and esophageal testing is safe.
Abstract:
We conducted a prospective study to determine the role of the esophagus in causing chest pain in patients with established CAD on optimum therapy. Thirty-two men with documented CAD who complained of frequent and usually daily retrosternal chest pain were evaluated. Following a standard esophageal manometry and acid perfusion test, simultaneous two-channel ambulatory Holter monitor and esophageal pH record tests were performed for 24 hours. Fifty-three episodes of chest pain were documented in 20 patients; 11 patients were free of pain. Of the 20 patients who complained of chest pains, 17 (85 percent) demonstrated at least one episode of PPR, defined as a drop in distal esophageal pH to less than 4 within ten minutes before or after the onset chest pain. Episodes of asymptomatic GER were common. The correlation of PPR with chest pain was 70 percent (37/53 episodes) and of ischemic ECG changes with chest pain 13 percent (7/53); in the remaining, there was no correlation with either. Two patients demonstrated simultaneous PPR and ischemic ECG changes. Seventeen esophageal motility abnormalities were observed in 14 patients (45 percent). It is our conclusion that esophageal disorders contribute to chest pain in patients with documented CAD. In this group, GER plays a greater role than in those with normal coronary arteries. In addition, esophageal motility disorders are common in these patients. Esophageal testing can be undertaken safely in these patients.