The Contribution of Gastroesophageal Reflux to Chest Pain in Patients with Coronary Artery Disease

Singh, Swapnil; Richter, Joel E.; Hewson, Edward G.; Sinclair, Jane W.; Hackshaw, Barry T.

doi:10.7326/0003-4819-117-10-824

Cited by 91 publications

(52 citation statements)

References 26 publications

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“…16 Although the omeprazole test has been shown to be an accurate diagnostic test, the duration of treatment and the optimal dose remain issues of controversy in the literature. Some authors [17][18][19] suggested that 6 to 8 weeks of treatment is necessary for diagnostic accuracy. However, it is impractical and expensive to have patients complete a full 2 months of antireflux treatment before it is determined whether the medication is of benefit.…”

Section: Commentmentioning

confidence: 99%

Clinical and Economic Assessment of the Omeprazole Test in Patients With Symptoms Suggestive of Gastroesophageal Reflux Disease

Fass¹,

Ofman²,

Im³

et al. 1999

Arch Intern Med

184

132

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Objective: To evaluate the diagnostic accuracy of a trial of a high-dose proton pump inhibitor (the omeprazole test) in detecting gastroesophageal reflux disease (GERD) in patients with heartburn symptoms.Design: A randomized, double-blind, placebocontrolled, crossover trial.Patients and Setting: Forty-three consecutive patients with symptoms suggestive of GERD were enrolled at a Veterans Affairs medical center.Main Outcome Measures: Symptom response to the omeprazole test vs placebo in GERD-positive and GERDnegative patients; sensitivity, specificity, and positive and negative predictive values of the omeprazole test; and cost per correct diagnosis achieved with the omeprazole test compared with traditional diagnostic strategies.Results: Of 42 patients (98%) who completed the study, 35 (83%) were classified as GERD positive and 7 (17%) as GERD negative. Twenty-eight GERD-positive and 3 GERD-negative patients responded to the omeprazole test, providing a sensitivity of 80.0% (95% confidence interval, 66.7%-93.3%) and a specificity of 57.1% (95% confidence interval, 20.5%-93.8%). Economic analysis revealed that the omeprazole test saves $348 per average patient evaluated, and results in a 64% reduction in the number of upper endoscopies performed and a 53% reduction in the use of pH testing. Conclusions:The omeprazole test is sensitive and fairly specific for diagnosing GERD in patients with typical GERD symptoms. This strategy could result in significant cost savings and decreased use of invasive diagnostic tests.

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Section: Commentmentioning

confidence: 99%

Clinical and Economic Assessment of the Omeprazole Test in Patients With Symptoms Suggestive of Gastroesophageal Reflux Disease

Fass¹,

Ofman²,

Im³

et al. 1999

Arch Intern Med

184

132

View full text Add to dashboard Cite

show abstract

“…In one study, chest pain evaluated by cardiologists was clinically misdiagnosed as cardiac disease in 25% of patients (17). A number of previous studies have provided evidence that the reflux prevalence is over 40% in patients with CAD, with 40-70% of cases of reflux being directly associated with chest pain symptoms (18)(19)(20)(21)(22)(23). However, this study is the first to investigate acid reflux in patients with CAD and refractory chest pain.…”

Section: Discussionmentioning

confidence: 89%

“…Lux et al showed that 57% of patients with CAD have chest pain correlated with acid reflux (20). Singh et al investigated symptomatic coronary patients and found that 41% of such patients have acid reflux (21).…”

Section: Discussionmentioning

confidence: 99%

Acid Reflux in Patients with Coronary Artery Disease and Refractory Chest Pain

Liu

Chen

et al. 2013

Intern. Med.

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Objective To investigate the influence of acid reflux on chest pain and ischemic events and the effects of cardiac drugs on acid reflux in patients with coronary artery disease (CAD) and refractory chest pain. Methods Simultaneous 24-hour esophageal pH monitoring and 24-hour continuous electrocardiogram (ECG) (Holter) results were obtained for 64 patients. Ischemic events and cardiac drug prescriptions were compared between the patients with and without gastroesophageal reflux disease (GERD). Patients fulfilling the GERD criteria received 14-day therapy with omeprazole at a dose of 20 mg bid. The results of the 24-hour pH monitoring, Holter and the SF-36 questionnaire were compared before treatment and again after two weeks of therapy. Results GERD was identified in 38 (69%) patients, with 49% of all chest pain occurring in association with acid reflux. A higher incidence (p=0.033) and longer duration (p=0.040) of ischemic events were observed in the GERD (+) patients. More frequent combined use of cardiac drugs was found in the GERD (+) patients. However, fewer ischemic events and greater total SF-36 survey scores were noted after PPI therapy in the GERD (+) patients. Conclusion Acid reflux is common in patients with CAD and refractory chest pain. Refractory chest pain in patients with CAD can be partially noncardiac chest pain (NCCP) secondary to acid reflux. The combined use of common cardiac drugs may predispose or aggravate GERD. Short-term proton pump inhibitor (PPI) therapy not only restores a normal esophageal pH, but also significantly improves the general health-related quality of life (HRQL) of patients.

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“…Pacientes com refluxo esofagiano podem apresentar desconforto torácico, geralmente em queimação (pirose), mas que às vezes é definido como uma sensação opressiva, localizada na região retroesternal ou subesternal, podendo se irradiar para o pescoço, braços ou dorso, às vezes associada à regurgitação alimentar, e que pode melhorar com a posição ereta ou com o uso de antiácidos, mas também com nitratos, bloqueadores dos canais de cálcio ou repouso [41][42][43] . A dor da úlcera péptica geralmente se localiza na região epigástrica ou no andar superior do abdômen mas às vezes pode ser referida na região subesternal ou retroesternal.…”

Section: Causas De Dor Torácica E Diagnóstico Diferencialunclassified

I Diretriz de Dor Torácica na Sala de Emergência

Bassan¹,

Pimenta²,

Timerman³

et al. 2002

Arq. Bras. Cardiol.

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ApresentaçãoEsta Diretriz se propõe a levar ao médico que atua na sala de emergência ou em centros de pronto-atendimentos os conceitos mais modernos e cientificamente aceitos e recomendados para o apropriado manejo diagnóstico e terapêutico de pacientes que procuram estes locais devido à dor ou desconforto torácico (ou no peito). As recomendações aqui formuladas se aplicam aos pacientes com dor aguda ou de início recente, de curta ou longa duração, podendo estar a dor presente ou não no momento deste atendimento. As recomendações não se aplicam aos pacientes com dor torácica com duração de alguns dias e que são atendidos em consultório ou ambulatório. Níveis de evidência (para a Recomendação): A) existência de grandes ensaios clínicos randomizados e/ou metanálise convincente; B) existência de estudos clínicos e/ou observacionais bem desenhados e com suficiente número de casos e de desfechos; C) existência de série (s) e/ou relatos de casos; D) existência de publicações de consensos de especialistas e/ou diretrizes societárias. Esta 1) IntroduçãoEstima-se que cinco a oito milhões de indivíduos com dor no peito ou outros sintomas sugestivos de isquemia miocárdica aguda sejam vistos anualmente nas salas de emergência nos Estados Unidos 1,2 . Esse número representa cerca de 5 a 10% de todos os atendimentos emergenciais naquele país 3,4 . Como a maioria desses pacientes são internados para avaliar-se uma possível síndrome coronariana aguda, isto gera um custo médio estimado de 3 a 6 mil dóla-res por paciente 5,6 . Ao final desse processo diagnóstico, cerca de 1,2 milhão de pacientes recebem o diagnóstico de infarto agudo do miocárdio (IAM) e outro tanto de angina instável. Por conseguinte, cerca da metade a 2/3 dos pacientes com dor torácica internados acabam não confirmando uma causa cardíaca para os seus sintomas 2,3 , resultando num gasto desnecessário de 5 a 8 bilhões de dólares por ano nos Estados Unidos 2,7,8 . No nosso País não existem números ou estimativas da quantidade de atendimentos por dor torácica nas salas de emergência. Dados do DATASUS e do Ministério da Saúde indicam a ocorrência de perto de 76.600 mortes por doença isquêmica do coração em 1999 (incluindo 58.000 por infarto agudo do miocárdio) 9 . Nesse ano, o número de internações por infarto agudo do miocárdio na rede pública e conveniada com o SUS (cerca de 6.400 hospitais do total de 7.100 hospitais no País) foi de 37.650, com 6.250 óbitos hospitalares (16,6%) 10 , número de internações 3,5% maior que o valor médio visto no período de 1993-1997 11 .Baseado no número de atendimentos anuais por dor torácica nos EUA e na proporção populacional entre esse país e o Brasil, e assumindo a mesma prevalência de doença coronariana, poderíamos estimar um quantitativo de 4 milhões de atendimentos anuais por dor torácica no Brasil. Como diversos estudos indicam que 5 a 15% dos pacientes atendidos com dor torácica nas salas de emergência norteamericanas têm infarto agudo do miocárdio, o quantitativo de infartos esperado no nosso País seria de aproximadam...

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The Contribution of Gastroesophageal Reflux to Chest Pain in Patients with Coronary Artery Disease

Cited by 91 publications

References 26 publications

Clinical and Economic Assessment of the Omeprazole Test in Patients With Symptoms Suggestive of Gastroesophageal Reflux Disease

Clinical and Economic Assessment of the Omeprazole Test in Patients With Symptoms Suggestive of Gastroesophageal Reflux Disease

Acid Reflux in Patients with Coronary Artery Disease and Refractory Chest Pain

I Diretriz de Dor Torácica na Sala de Emergência

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