Acid Reflux in Patients with Coronary Artery Disease and Refractory Chest Pain

Abstract

Objective To investigate the influence of acid reflux on chest pain and ischemic events and the effects of cardiac drugs on acid reflux in patients with coronary artery disease (CAD) and refractory chest pain. Methods Simultaneous 24-hour esophageal pH monitoring and 24-hour continuous electrocardiogram (ECG) (Holter) results were obtained for 64 patients. Ischemic events and cardiac drug prescriptions were compared between the patients with and without gastroesophageal reflux disease (GERD). Patients fulfilling the GERD criteria received 14-day therapy with omeprazole at a dose of 20 mg bid. The results of the 24-hour pH monitoring, Holter and the SF-36 questionnaire were compared before treatment and again after two weeks of therapy. Results GERD was identified in 38 (69%) patients, with 49% of all chest pain occurring in association with acid reflux. A higher incidence (p=0.033) and longer duration (p=0.040) of ischemic events were observed in the GERD (+) patients. More frequent combined use of cardiac drugs was found in the GERD (+) patients. However, fewer ischemic events and greater total SF-36 survey scores were noted after PPI therapy in the GERD (+) patients. Conclusion Acid reflux is common in patients with CAD and refractory chest pain. Refractory chest pain in patients with CAD can be partially noncardiac chest pain (NCCP) secondary to acid reflux. The combined use of common cardiac drugs may predispose or aggravate GERD. Short-term proton pump inhibitor (PPI) therapy not only restores a normal esophageal pH, but also significantly improves the general health-related quality of life (HRQL) of patients.

Risk of acute myocardial infarction in patients with gastroesophageal reflux disease: A nationwide population-based study

“…Various studies have reported angina suppression as the result of GERD therapy. Liu Y et al have found that two-week PPI therapy not only reduced cardiac ischemia, but also improved health-related quality of life in patients with CAD and GERD [26]. Dobrzycki and colleagues have shown that short-term PPIs therapy reduced the duration and number of ST-segment depression episodes in patients with GERD and CAD [15].…”

Acute Coronary Syndrome: An Unusual Consequence of GERD

“…The authors also demonstrated significant improvement in ST-segment depression episodes and total ischemic burden following a 7-day course of proton pump therapy (PPI) in patients with GERD suggesting that restoring normal esophageal pH might eliminate acid-derived esophagocardiac reflex and hence myocardial ischemia [ 11 ]. Liu et al reported similar findings of longer duration and higher incidence of ischemic events in patients with CAD and gastric reflux [ 12 ]. Short course of PPI not only resulted in fewer ischemic events, but also significantly improved the general health-related quality of life of patients [ 12 ].…”

“…Liu et al reported similar findings of longer duration and higher incidence of ischemic events in patients with CAD and gastric reflux [ 12 ]. Short course of PPI not only resulted in fewer ischemic events, but also significantly improved the general health-related quality of life of patients [ 12 ]. Furthermore, Swiatowski et al demonstrated that 14 days of PPI therapy in 34 patients with GERD and CAD caused a significant increase in the amount of time before maximal ST depression occurred during exercise stress test, showing that PPI therapy has a favorable effect on cardiac reserve [ 13 ].…”

Value of the Gastroesophageal Reflux Disease Questionnaire (GerdQ) in predicting the proton pump inhibitor response in coronary artery disease patients with gastroesophageal reflux-related chest pain

“…In our study, we also analyzed the rate of anti‐anginal drug administration in the two groups. Because we found that the combinations of CCB, antiplatelet drugs, and nitrates, and the combination of CCB, antiplatelet drugs, β‐blockers, and nitrates were more frequent in the patients with GERD and CAD in our previous study, we compared the prescription of combined CCB, antiplatelet drugs, and nitrates, and the combination of CCB, antiplatelet drugs, β‐blockers, and nitrates in this study, and obtained the same result.…”