It is well known that non-cardiac chest pain is closely related to gastroesophageal reflux diseases (GERD). Chest pain of esophageal origin can be difficult to distinguish from that caused by cardiac ischemia because the distal esophagus and the heart share a common afferent vagal supply, and GERD can cause episodes of non-cardiac chest pain that resemble ischemic 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 will be published on April 14, 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 ischemia were defined as ST segment depression based on the Minnesota code.
Among 712 patients (36%) with GERD, ECG was performed in 171 (24%), and ischemic 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-GERD heartburn, which may be related to ischemic 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 ischemia, the prevalence of linked angina was considered to be 0.4% (8/1970 patients).
The study results suggest that an extra-esophageal condition causes GERD symptoms and that angina may be misclassified as GERD. Since patients with GERD have an increased risk of angina pectoris in the year after GERD diagnosis, physicians have to be concerned about missing clinically important CAD while evaluating patients for GERD symptoms.
Reference: Kato H, Ishii T, Akimoto T, Urita Y, Sugimoto M. Prevalence of linked angina and gastroesophageal reflux disease in general practice. World J Gastroenterol 2009; 15(14): 1764-1768. http://www.wjgnet.com/1007-9327/15/1764.asp
Correspondence to: Dr. Yoshihisa Urita, Department of General Medicine and Emergency Care, Toho University School of Medicine, Omori Hospital, 6-11-1, Omori-Nishi, Ota-Ku, Tokyo 143-8541, Japan. foo@eb.mbn.or.jp
About World Journal of Gastroenterology
World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H pylori infection and provides a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health. ISI JCR 2003-2000 IF: 3.318, 2.532, 1.445 and 0.993. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th day of every month. WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the name of China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.
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World Journal of Gastroenterology