Esophageal Contribution to Chest Pain in Patients with Coronary Artery Disease

Garcia-Pulido, J; Patel, Pravichandra H.; Hunter, William C.; Douglas, John E.; Thomas, Eapen

doi:10.1378/chest.98.4.806

Cited by 55 publications

(29 citation statements)

References 48 publications

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“…However, in a large fraction of those patients, cardiac and esophageal abnormalities may coexist [13]. Furthermore, it has been reported that a high proportion of chest pain episodes (up to 70%) in patients with coronary artery disease correlate with gastroesophageal reflux [14]. …”

Section: Noncardiac Chest Painmentioning

confidence: 99%

Nongastrointestinal Disorders in the Irritable Bowel Syndrome

et al. 2000

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A large proportion of irritable bowel syndrome (IBS) patients also complain of other functional disorders, such as headache, noncardiac chest pain, low back pain, and dysuria. Some of these features, particularly headache, may have a negative influence on the outcome of IBS. In a large proportion of female IBS patients, sexual intercourse triggers the symptoms, and frequently IBS symptoms exacerbate during menses. These gynecological-type symptoms often mislead the patients to the gynecological clinic, which may imply unnecessary investigations and inappropriate treatments. The diagnostic criteria of the fibromyalgia syndrome include IBS, and hence, the apparent relationship of both syndromes is difficult to analyze. On the other hand, no convincing evidence has been produced to date to sustain an association between IBS and the chronic fatigue syndrome.

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Section: Noncardiac Chest Painmentioning

confidence: 99%

Nongastrointestinal Disorders in the Irritable Bowel Syndrome

et al. 2000

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“…In one study, chest pain evaluated by cardiologists was clinically misdiagnosed as cardiac disease in 25% of patients (17). A number of previous studies have provided evidence that the reflux prevalence is over 40% in patients with CAD, with 40-70% of cases of reflux being directly associated with chest pain symptoms (18)(19)(20)(21)(22)(23). However, this study is the first to investigate acid reflux in patients with CAD and refractory chest pain.…”

Section: Discussionmentioning

confidence: 89%

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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“…Investigations over the past two decades have not found a specific cause for syndrome X. Patients with angina-like chest pain usually have a history of many years on drugs that have a spasmolytic action not only on the smooth muscle cells of the blood vessels but also on those of the esophagus, as well as decreased lower esophageal sphincter and impaired esophageal clearing [5, 6, 7]. Many syndrome X patients are considered to have esophageal dysfunction [8, 9, 10].…”

Section: Introductionmentioning

confidence: 99%

Evidence of Abnormal Esophageal Motility in Syndrome X by Radionuclide Esophageal Transit Test

Kao

Hsieh²,

Tsai³

et al. 2000

Digestion

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In 30 patients with syndrome X, esophageal motility was evaluated by radionuclide esophageal transit test (RETT). Esophageal motility measurements included esophageal mean transit time (MTT), residual fraction (RF), and retrograde index (RI). In comparison with 25 age- and sex-matched healthy volunteers, 66% of the patients with syndrome X had abnormal RETT findings including 50% of cases with longer MTT, 50% of cases with higher RF, and 33% of cases with higher RI. In addition, the mean values of MTT, RF, and RI in patients with syndrome X were significantly higher than those of healthy volunteers. We conclude that abnormal esophageal motility occurred in a large portion of syndrome X patients based on an simple and noninvasive RETT.

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Esophageal Contribution to Chest Pain in Patients with Coronary Artery Disease

Cited by 55 publications

References 48 publications

Nongastrointestinal Disorders in the Irritable Bowel Syndrome

Nongastrointestinal Disorders in the Irritable Bowel Syndrome

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

Evidence of Abnormal Esophageal Motility in Syndrome X by Radionuclide Esophageal Transit Test

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