Angina and gastroesophageal reflux diseases linked

30 April 2009

It is well known that non-cardiac chest pain is closely related to gastro-oesophageal reflux diseases (GORD). Chest pain of oesophageal origin can be difficult to distinguish from that caused by cardiac ischaemia because the distal oesophagus and the heart share a common afferent vagal supply, and GORD can cause episodes of non-cardiac chest pain that resemble ischaemic cardiac pain.

A research team led by Dr Yoshihisa Urita from Toho University School of Medicine investigated the association between gastroesophageal reflux diseases (GERD) and coronary heart diseases. Their study was published 14 April 2009 in the World Journal of Gastroenterology.

One thousand nine hundred and seventy consecutive patients were enrolled in this study. All of the patients who first attend their hospital were asked to respond to the F-scale questionnaire regardless of their chief complaints. All patients had a careful history taken, and resting echocardiography (ECG) was performed by physicians if the diagnostic necessity arose. Patients with ECG signs of coronary artery ischaemia were defined as ST segment depression based on the Minnesota code.

Among 712 patients (36%) with GORD, ECG was performed in 171 (24%), and ischaemic changes were detected in eight (5%). Four (50%) of these patients with abnormal findings upon ECG had no chest symptoms such as chest pain, chest oppression, or palpitations. These patients (0.6%; 4/712) were thought to have non-GORD heartburn, which may be related to ischaemic heart disease. Of the 281 patients who underwent ECG and did not have GERD symptoms, 20 (7%) had abnormal findings upon ECG. In patients with GERD symptoms and ECG signs of coronary artery ischaemia, the prevalence of linked angina was considered to be 0.4% (8/1970 patients).

The study results suggest that an extra-oesophageal condition causes GORD symptoms and that angina may be misclassified as GORD. Since patients with GORD have an increased risk of angina pectoris in the year after GORD diagnosis, physicians have to be concerned about missing clinically important CAD while evaluating patients for GORD symptoms.

(Source: Toho University School of Medicine: World Journal of Gastroenterology: April 2009)