Cardioesophageal reflexes: An invasive human study

Makk, L; Joseph, A.E.A.; Prince, Charles L.; Leesar, Massoud A.; Wright, Ronald

doi:10.1016/s0016-5085(98)80857-3

Cited by 6 publications

(18 citation statements)

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“…These observations suggest a strict relationship between the heart and the esophageal system. Accordingly, neural reflex arcs from the esophagus to the heart have been shown in both animals and humans (7,10,17,19). On the one hand, esophageal provocation with ice water, hydrochloric acid, and balloon inflation may influence coronary blood flow in humans (7,17).…”

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confidence: 99%

“…Accordingly, neural reflex arcs from the esophagus to the heart have been shown in both animals and humans (7,10,17,19). On the one hand, esophageal provocation with ice water, hydrochloric acid, and balloon inflation may influence coronary blood flow in humans (7,17). On the other hand, patients with chest pain and normal coronary arteries are often found to develop esophageal spasm during a variety of cardiac procedures (17).…”

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confidence: 99%

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Coronary spasm reflects inputs from adjacent esophageal system

Manfrini

Bazzocchi²,

Luati³

et al. 2006

American Journal of Physiology-Heart and Circulatory Physiology

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Mechanisms underlying coronary spasm are still poorly understood. The aim of the study was to assess the hypothesis that fluctuations in the development of coronary spasm might reflect inputs from the adjacent esophageal system. We enrolled patients admitted to the coronary care unit for episodes of nocturnal angina. Seven patients with variant angina and five with coronary artery disease (CAD) had concurrent ECG and esophageal manometric monitoring. ECG monitoring documented 28 episodes of ST elevation in variant angina patients and 16 episodes of ST depression in CAD patients. Manometric analysis showed that esophageal spasms resulted remarkably more frequently in variant angina patients (143 total spasms; individual range 9-31) than in CAD patients (20 total spasms; individual range 0-9; P < 0.01). Time series analysis was used to assess fluctuations in the occurrence of abnormal esophageal waves and its relationship with spontaneous episodes of ST shift. Episodes of esophageal spasm in CAD were sporadic (<1 in 30 min) and not related to ECG-recorded ischemia. In the variant angina group, esophageal spasms were time related to ischemia (>1 into 5 min before ECG-recorded ischemia) (P < 0.05). A bidirectional analysis of causal effects showed that the influence processes between esophageal and coronary spasms were mutual and reciprocal (transfer function model, P < 0.05) in variant angina. We concluded that in variant angina patients, episodes of esophageal spasms and myocardial ischemia influenced each other. Mechanisms that cause esophageal spasm can feed back to produce coronary spasm. Coronary spasm may feed forward to produce additional episodes of esophageal spasm.

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confidence: 99%

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confidence: 99%

Coronary spasm reflects inputs from adjacent esophageal system

Manfrini

Bazzocchi²,

Luati³

et al. 2006

American Journal of Physiology-Heart and Circulatory Physiology

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“…It is becoming clear that the esophageal and extraesophageal symptoms of GERD such as chest pain may also be associated with both acid reflux (esophageal pH 4-7) and non-acid reflux (2). However, previous studies have demonstrated that among the CAD patients experiencing chest pain, over 50% have acid reflux disease as the cause of noncardiac chest pain (3,4). The role of non-acid gastroesophageal reflux in patients with CAD experiencing chest pain should be investigated in a future study.…”

Section: Mehta Et Al Investigated Only 24 Patients (24)mentioning

confidence: 99%

“…Evaluating the symptoms themselves is not sufficient to predict the underlying disease. Because the distal esophagus and heart share a common afferent vagal supply, mechanical and/or chemical stimulation of the esophagus can evoke myocardial ischemia, leading to chest pain (2)(3)(4)(5). In fact, noncardiac chest pain (NCCP) gastroesophageal reflux occurs at the same frequency in patients with normal and pathological coronary angiographies.…”

Section: Introductionmentioning

confidence: 99%

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

Liu

Chen

et al. 2013

Intern. Med.

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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.

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“…Since the oesophagus and the heart share their innervation, mechanical or chemical stimulation of the oesophagus may evoke myocardial ischemia leading to chest pain both in experimental animals and in humans. This phenomenon has been designated as linked-angina [15][16][17][18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%