The favourable effect of Helicobacter pylori eradication therapy in patients with recurrent angina-like chest pain and non-responsive to proton pump inhibitors – a preliminary study

Abstract

IntroductionThe outcome of Helicobacter pylori (Hp) eradication therapy from the aspect of prevention of chest pain recurrence is still uncertain. The aim of this study was to assess the influence of Hp eradication therapy on the risk of hospitalization due to acute coronary syndrome.Material and methodsThe analysis was carried out in 63 consecutive patients with recurrent retrosternal symptoms: 28 (44%) with significant coronary artery narrowing in coronarography not qualified for revascularization by an invasive cardiologist, and 35 (56%) with no obstructive coronary artery lesions. In 33 (52%) of the patients, Hp infection was found and standard eradication therapy with omeprazole (2 × 20 mg), amoxicillin (2 × 1 g) and metronidazole (2 × 500 mg) was recommended. The mean follow-up period was 977 ±249 days.ResultsChest pain requiring hospitalization because of unstable angina within the follow-up period was observed in 9 (27%) of the Hp-infected individuals and in 15 (50%) subjects in whom a urease test and histology did not confirm this infection (p = 0.055). The recommendation of Hp-eradication treatment was a significant factor prolonging the hospitalization-free period, both in the two Kaplan-Meier curve analyses (Cox’s F test = 1.96; p = 0.049) and the Cox proportional hazard model (beta = –1.18; p = 0.045), but was weaker than the effect of the non-obstructive coronary angiogram (beta = –1.45; p = 0.03).ConclusionsThe recommendation of Hp-eradication therapy may prolong the hospitalization-free period for patients with recurrent chest pain.

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

“…Their synthesis may be stimulated in the course of many of the diseases of the alimentary tract, such as periodontal diseases, oesophagitis, gastritis, ileitis, inflammatory bowel diseases, liver cirrhosis, pancreatitis, and neoplasm (Shanker & Kakkar, 2009;Stőlberger & Finsterer, 2003). Some reports, including my own data, have also shown the unfavourable effect of Helicobacter pylori infection, not only on the course of digestive tract diseases, but also on the course of recurrent angina-like chest pain (Budzyński, 2011), changes in autonomic nervous system balance (Budzyński et al, 2004) and atherosclerosis progression (Franceschi et al, 2009). CagA seropositivity has been significantly and positively associated with the occurrence of acute coronary events, atherosclerosis progression and arrhythmia prevalence (Bunch et al, 2008a(Bunch et al, , 2008bFrancesci et al, 2009;Miyazaki et al, 2006).…”

“…Our own, recently published investigation has shown that patients with recurrent angina-like chest pain non-responsive to treatment with PPIs and an established diagnosis of exercise-provoked oesophageal spasm (EPOS), for whom a calcium antagonist was recommended due to exercise-provoked oesophageal spasm, had a significantly lower risk of hospitalization due to suspected acute coronary syndrome in the 2.7-year follow-up period than the remaining patients (NNT = 3.5) (Budzyński et al, 2010). In my own work it has been documented that Hp eradication had a similar favourable outcome (NNT = 2.7) (Budzyński, 2011). The rationales behind this therapy were the above-cited role of this infection in chest pain pathogenesis both cardiac and gastroenterological in origin.…”

“…VCAM-1, ICAM-1); the over-synthesis of pro-atherogenic cytokines (e.g. IL-1 beta, IL-6, TNF-alpha); changes in autonomic nervous system balance (Budzyński et al, 2004;Budzyński, 2011;Celik et al, 2010;Rasmi & Raeisi, 2009); and the production of metabolic abnormalities, such as hypertriglyceridaemia, increased LDL cholesterol levels, plasma lipid oxidation, hyperfibrinogenaemia, altered blood coagulation and leukocytosis. The role of Hp infection as a cause of myocarditis and ECG changes in patients with persistent chest pain has also been reported (Navarese et al, 2010).…”

“…Individuals with angina-like chest pain with normal coronary angiogram and patients with CAD and overlapping gastroenterological symptoms may achieve symptomatic improvement after therapy oriented to oesophageal disorders (Phan et al, 2009). Such therapy may consist of long-term treatment with PPIs, therapy with calcium antagonists (Budzyński, 2010a;Budzyński et al, 2010), Helicobacter pylori eradication (Budzyński, 2011), as well as tricyclic antidepressants (Eslick, 2008;Fass, 2008;Fass & Navarro-Rodriguez, 2008), selective serotonin reuptake inhibitors (citalopram, sertaline) or trazodone (Broekaert et al, 2006). Recent studies have also indicated the favourable effect of theophylline (Rao et al, 2007), botulinum toxin (Achem, 2008;Fass & Navarro-Rodriguez, 2008), acupuncture (Dickman et al, 2007b;Macpherson and Dumville, 2007;Pfab et al, 2011), melatonin due to its positive cardiological and gastroenterological action (Dominiguez-Rodriguez et al, 2009;Konturek et al, 2008;Pereira, 2006), hypnotherapy (Jones et al, 2006;Palsson and Whitehead, 2006), transcutaneous electrical nerve stimulation (TENS) (Borjesson et al, 1998), oesophageal dilatation, oesophagomyotomy and Nissen fundoplication (Achem, 2008;Phan et al, 2009).…”

Headache immunology

“…На основе полученных данных ученые предлагают рассматривать хеликобактерную инфекцию в качестве этиологического фактора мигрени. Кроме того, по данным литературы [17][18][19], в результате направленного на ликвидацию инфекции H. pylori лечения происходит снижение частоты, интенсивности и продолжительности приступов мигрени.…”