Original research Treatment with double dose of omeprazole increases -endorphin plasma level in patients with coronary artery disease

Abstract

IntroductionThe proton pump inhibitor empirical trial, besides the analysis of symptoms, is the main method in the diagnosis of gastro-oesophageal reflux disease-related chest pain. β-Endorphin acts as an endogenous analgesia system. The aim of the study was verify whether β-endorphin plasma level is affected by omeprazole administration and influences the severity of anginal symptoms and outcome of the “omeprazole test” in patients with coronary artery disease (CAD) and chest pain of suspected non-cardiac origin.Material and methodsOmeprazole was administered to 48 patients with CAD in a randomized, placebo-controlled, crossover study design. At the beginning of the study, and again after the 14-day omeprazole and placebo treatment, the β-endorphin plasma concentration was determined.ResultsThe level of plasma β-endorphin after the administration of omeprazole was significantly greater than at the start of the study and following the placebo. Responders to omeprazole had an average lower β-endorphin plasma concentration than subjects who failed to respond to this therapy. Subjects with symptoms in class III (according to the Canadian Cardiovascular Society classification) after omeprazole administration had a greater β-endorphin plasma level than subjects in class II for anginal symptom severity.ConclusionsFourteen-day therapy with a double omeprazole dose significantly increases the β-endorphin plasma concentration in patients with CAD. Circulating β-endorphin does not seem to be involved in the mechanism for the “omeprazole test” outcome, although an individually different effect on pain threshold cannot be excluded.

Does esophageal dysfunction affect the course of treadmill stress test in patients with recurrent angina-like chest pain?

“…Their observations con firmed the role of neural reflexes in the pathogen esis of cardioesophageal associations but with lit tle use in everyday clinical practice. results of treadmill stress test after therapy with PPI may be related to other potential mechanisms, such as an increase in β endorphin 27 and nitric oxide 28 secretion.…”

Angina-Like Chest Pain as a Symptom of Digestive Tract Disorders

“…However, due to possible potential dangerous interactions between clopidogrel and PPIs, this test should be avoided in patients on dual anti-platelet therapy (ACCF, 2010;Bhatt et al, 2008). Our own investigations have also shown the necessity for careful interpretation of testing with PPIs due to an increase found in nitric oxide bioavailability after rabeprazole therapy (Kłopocka et al, 2006) and beta-endorphin plasma levels (Budzyński et al, 2010). These substances produced during therapy with PPIs may mask the true chest pain source, including that of cardiac in origin.…”

“…My own experience has shown the clinical usefulness of exercise-provoked oesophageal dysmotility diagnosis using simultaneous oesophageal manometry and ECG monitoring during a treadmill stress test. Some exercise-provoked oesophageal motility disorder appeared in 22% of patients with recurrent angina-like chest pain non-responsive to empirical therapy with PPIs (Budzyński et al, 2010;Budzyński, 2010a). The occurrence of angina-like chest pain, oesophageal acidification for more than 10 s, and increased simultaneous contractions above 55% during a treadmill stress test had greater than 80% specificity for diagnosing GER-related and non-GER-related chest pain.…”

Gastroesophageal Reflux Disease and Coronary Heart Disease: Is There a “Mutual Burden” Syndrome?

“…Уменьшение болевых ощущений в груди у больных ИБС на фоне приема ИПП может быть следствием феномена висцеро-висцеральной гипералгезии, когда при лечебном воздействии на один из взаимодействующих органов проявляется положительный эффект в отношении другого [17]. Кроме того, объяснить причину улучшения симптомов стенокардии может факт стимуляции эндогенной системы анальгезии под влиянием ИПП в виде увеличения уровня β-эндорфина в плазме крови [39].…”