Does gastro-esophageal reflux provoke the myocardial ischemia in patients with CAD?

Int J Cardiol. 2005 Sep 15;104(1):67-72. doi: 10.1016/j.ijcard.2004.10.018.


Background: Gastro-esophageal reflux disease (GERD) may cause chest pain. The aim was to determine the correlation between ischemia and gastro-esophageal reflux in patients with CAD and to assess the influence of short-term "anti-reflux" therapy on the ischemia in patients with GERD and CAD.

Methods: Fifty patients with angiographically proven CAD underwent simultaneous 24-h continuous ECG and esophageal pH monitoring. We assessed the number of ST-segment depression episodes (ST dep.) and total duration of ischemic episodes, expressed as total ischemic burden (TIB). In pH-metry, we assessed: time percentage of pH lower than 4, total time of pH lower than 4 and the number of pathological refluxes (PR). Patients fulfilling the GERD criteria received a 7-day therapy with omeprazole 20 mg bid. On the 7th day of therapy, simultaneous Holter and esophageal pH monitoring was repeated.

Results: Total number of 224 PRs in 42 patients (84%) was recorded during esophageal pH-metry. GERD criteria were fulfilled in 23 patients (46%). Out of 218 episodes of ST dep., 45 (20.6%) correlated with PR. GERD patients had larger TIB and higher number of ST dep. (p<0.015 and p<0.035, respectively). The anti-reflux therapy reduced all analyzed parameters of esophageal pH monitoring (p<0.0022) as well as the number of ST dep. (p<0.012) and TIB (p<0.05).

Conclusions: Gastro-esophageal reflux disease is common in patients with CAD and may provoke myocardial ischemia. Short-term proton pump inhibitors therapy that restores normal esophageal pH significantly reduces myocardial ischemia, possibly due to elimination of acid-derived esophago-cardiac reflex compromising coronary perfusion-the phenomenon known as "linked angina".

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Anti-Ulcer Agents / therapeutic use
  • Circadian Rhythm / drug effects
  • Coronary Artery Disease / complications*
  • Coronary Artery Disease / physiopathology
  • Electrocardiography, Ambulatory
  • Female
  • Gastroesophageal Reflux / complications*
  • Gastroesophageal Reflux / drug therapy
  • Gastroesophageal Reflux / physiopathology
  • Humans
  • Hydrogen-Ion Concentration / drug effects
  • Male
  • Middle Aged
  • Myocardial Contraction*
  • Myocardial Ischemia / etiology*
  • Myocardial Ischemia / physiopathology
  • Omeprazole / therapeutic use
  • Time Factors
  • Treatment Outcome


  • Anti-Ulcer Agents
  • Omeprazole