Syntropy - gastroesophageal reflux disease and ischemic heart disease - diagnostic methods and treatment tactics
Keywords:
GERD, coronary artery disease, myocardial ischemiaAbstract
Studies describe chest pain as the common symptom for the association of gastroesophageal reflux disease (GERD) and coronary artery disease (ICD). Among the patients evaluated at the emergency department for chest pain >50% do not show signs of coronary ischemia and require further investigation. Materials and methods. The study was carried out by searching the articles that were published in the period 2016-2023, using the PubMed, NCIB, Medscape, Mendeley databases, using the keywords: „GERD”, „coronary artery disease”, „diagnosis” , „treatment”, as well as their association. Results. Both nosologies are clinically manifested by chest pain caused by gastrointestinal acid irritation, which activates the vagal reflex, and endothelial dysfunction, which causes ischemia and coronary vasoconstriction. Paraclinical findings are characterized by increased levels of IL1,6,8 and NO metabolites involved in disease pathogenesis. ECG and pH measurement for 24 h are sufficient at the first stage to determine the cause of attacks of recurrent chest pain. PPIs are the first line of treatment for chest pain relief in these patients. Conclusions. GERD and BCI represent diseases with a global impact, and the interdisciplinary therapeutic approach of these diseases, culminating in a targeted treatment program, determines the improvement of symptoms with an improvement of the patient’s quality of life.
References
1. Boeckxstaens G. E. Reflux inhibitors: a new approach for GARB. Curr. Opin. Pharmacol. 2018; 8 (6): pp. 685-689. https://doi.org/10.1016/j.coph.2008.08.005
2. Boulton H.A. et. al. A narrative review of the prevalence of gastroesophageal reflux disease (GERD). Annals of Esophagus 1. 2022. https://doi.org/10.21037/aoe-20-80
3. Francis D.O. et al. High economic burden of caring for patients with suspected extraesophageal reflux. Am J Gastroenterol 2013;108: 905-911. https://doi.org/10.1038/ajg.2013.69
4. Cassar A. et. al. Chronic coronary artery disease: diagnosis and management. Mayo Clin Proc. 2009;84(12):1130-1146. https://doi.org/10.4065/mcp.2009.0391
5. Kalra S. et al. Review of acute coronary syndrome diagnosis and management. Postgrad Med. 2008;120(1):18-27. https://doi.org/10.3810/pgm.2008.04.1756
6. Spiegel B.R. et al. Prevalence of Gastroesophageal Reflux Disease and Proton Pump Inhibitor-Refractory Symptoms, Gastroenterology. 2020.
7. Turpie A.G. Burden of disease: medical and economic impact of acute coronary syndromes. Am J Manag Care. 2006;12(16):430-434.
8. Katus H., Ziegler A. et al. Early diagnosis of acute coronary syndrome. Eur Heart J. 2017;38:3049-3055. https://doi.org/10.1093/eurheartj/ehx492
9. El-Serag H.B. et al. Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut. 2014;63:871-880. https://doi.org/10.1136/gutjnl-2012-304269
10. Su Y.K. Is Gastroesophageal Reflux Disease Really a Risk Factor for Acute Myocardial Infarction?. J Neurogastroenterol Motil. 2020;26:42. https://doi.org/10.5056/jnm20192
11. Chen L. et al. Association between gastroesophageal reflux disease and coronary heart disease: A nationwide population-based analysis. 2016; 95(27):40-89. https://doi.org/10.1097/MD.0000000000004089
12. Alekseeva O.P., Pikulev D.V. Gastroesophageal Reflux Disease and Coronary Heart Disease: Is There a "Mutual Burden" Syndrome?. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2019;29(4):66-73. https://doi.org/10.22416/1382-4376-2019-29-4-66-73
13. Ahmed H. et. al. Cardiac Involvement in Patients with Gastroesophageal Reflux Disease (GERD). Afro-Egyptian Journal of Infectious and Endemic Diseases. 2022;12(1): 66-74.
14. Cousins M.J. et al. Neural blockade: impact on outcome. Cousins and Bridenbaugh's Neural Blockade in Clinical Anesthesia and Pain Medicine.2009;4:144-146.
15. Katusic Z.S. et al. Endotelial nitric oxide: protector of a healthy mind. Europ. Heart J. 2014;35:888-894. https://doi.org/10.1093/eurheartj/eht544
16. Bulaeva N.I., Golukhova E.Z. Disfuncția endotelială şi stresul oxidativ: rol în dezvoltare patologia cardiovasculară. Cardiologie creativă. 2013;1:14-22.
17. Oparin A. The Role of Endothelial Dysfunction in the Mechanism of Gastroesophageal Reflux Disease Development in Patients with Ischemic Heart Disease. Acta Clinica Croatica. 2017. https://doi.org/10.20471/acc.2017.56.04.08
18. Rieder F. et al. Inflammatory mediators in gastroesophageal reflux disease: impact on esophageal motility, fibrosis, and carcinogenesis. American Journal of Physiology-Gastrointestinal and Liver Physiology. 2010;298(5):571-581. https://doi.org/10.1152/ajpgi.00454.2009
19. Xiumei Z. et. al. The prevalence of coronary atherosclerosis in patients with refractory gastroesophageal reflux disease ready for antireflux surgery. 2022;101:314-330. https://doi.org/10.1097/MD.0000000000031430
20. Lei W.Y. et al. Risk of acute myocardial infarction in patients with gastroesophageal reflux disease: a nationwide population-based study. PLoS One.2017;12. https://doi.org/10.1371/journal.pone.0173899
21. Liu Y. et al. Acid reflux in patients with coronary artery disease and refractory chest pain. Intern Med. 2013;52:1165-1171. https://doi.org/10.2169/internalmedicine.52.0031
22. Mellow M.H. A gastroenterologists view of chest pain. Current Problems in Cardiology. 1983;7(10): 3-36. https://doi.org/10.1016/0146-2806(83)90040-3
23. Yamasaki T. et. al. Update on Functional Heartburn. Gastroenterol. Hepatol. 2017;13:725-734.
24. Chung H. T. et. al. Seoul Consensus on the Diagnosis and Management of Gastroesophageal Reflux Disease. J Neurogastroenterol Motil 2021; 27(4):453-481. https://doi.org/10.5056/jnm21077
25. Foley J.R. et al. Assessment of stable coronary artery disease by cardiovascular magnetic resonance imaging: Current and emerging techniques. World J Cardiol. 2017;26;9(2):92-108. https://doi.org/10.4330/wjc.v9.i2.92
26. Nucifora G. et al. Coronary artery calcium scoring in cardiovascular risk assessment. Cardiovasc Ther. 2011;29(6):43-53. https://doi.org/10.1111/j.1755-5922.2010.00172.x
27. Department of Health Statistics and Informatics in the Information, Evidence and Research Cluster of the World Health Organization (WHO). Global health risks: mortality and burden of disease attributable to selected major risks. 2016.
28. Hui C. et. al. Acute Coronary Syndrome: An Unusual Consequence of GERD. Case Reports in Cardiology. 2015:1-4. https://doi.org/10.1155/2015/939641
29. Shiraev T. P. et al. Proton Pump Inhibitors and Cardiovascular Events: A Systematic Review. Heart Lung Circ. 2018;27(4):443-50. https://doi.org/10.1016/j.hlc.2017.10.020
30. Ariel H. et al. Cardiovascular Risk of Proton Pump Inhibitors. Methodist Debakey Cardiovasc J. 2019;15(3):214-219. https://doi.org/10.14797/mdcj-15-3-214
31. Mena M. et. al. Non-Cardiac chest pain: A review of Environmental exposureassociated Comorbidities and Biomarkers. EMJ Gastroenterol. 2018;7(1):103-112. https://doi.org/10.33590/emjgastroenterol/10313895
32. Benett J. et al. The differention between oesophageal and cardiac pain. The lancet. 1966; 288(7473):1123- 1127. https://doi.org/10.1016/S0140-6736(66)92209-4
33. Rosztóczy V. et. al. The evaluation of gastro-oesophageal reflux and oesophagocardiac reflex in patients with angina-like chest pain following cardiologic investigations. Int J Cardiol. 2007;118(1):62-68. https://doi.org/10.1016/j.ijcard.2006.05.035
34. Lobna A. Cardiac Involvement in Patients with Gastroesophageal Reflux Disease (GERD). Afro-Egyptian Journal of Infectious and Endemic Diseases. 2022;12(1): 66-74.
35. Sueda S. General internists of experience suspected variant angina as gastroesophageal reflux diseases in two cases: Heart burn may be related to coronary spasm. J Cardiol Cases. 2019. https://doi.org/10.1016/j.jccase.2019.10.008
36. Istrati V. et al. Sindromul Bergman şi boala de reflux gastroesofagian. In: Sănătate Publică, Economie şi Management în Medicină, 2013;5(50):34-36. ISSN 1729-8687.
37. Istrati V. et al. Boala de reflux gastroesofagian: manifestările clinice atipice şi impactul ei asupra calităţii vieţii pacienţilor. În: Curierul medical, 2010;3:78-81.
38. Scurtu A. Particularităţile clinico-paraclinice ale bolii de reflux gastroesofagian în raport cu metabolismul şi polimorfismul genetic al oxidului nitric. Teza de doctor in stiinte medicale. 2016.
39. Calin G., Istrati V., Sârbu O., Scorpan A., Scurtu A., Stoica M. Syntropia - boli acidodependente şi hipertensiune arterială. În: One Health and Risk Management, 2022;3(3):10-17. ISSN 2587-3458. https://doi.org/10.38045/ohrm.2022.3.02
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