Although crushing chest pain most often is indicative of myocardial ischemia, ischemic heart disease is excluded in one third of patients with angina-like chest pain. Many of these patients (up to 60%) have gastroesophageal reflux disease (GERD). The role of acid reflux in causing this chest pain is unknown, as is the effect of gastric acid suppression on symptoms.
In a study published in the October 2004 issue of The American Journal of Gastroenterology, Sanchoy Sarkar, PhD, MRCP, BSc, and colleagues examined the contribution of acid reflux to esophageal pain hypersensitivity in patients with GERD and unexplained chest pain (n = 14) and in healthy volunteers (n = 8). Results showed that patients with GERD have a lower resting upper esophageal pain threshold (PT; measured by electric stimulation), compared with controls (40.8 + 9 mA vs 70.4 + 11 mA; P = .03).
Acid infusion reduced PTs in controls but not in patients. Six patients underwent a repeat study after 6 weeks of proton pump inhibitor (PPI) therapy. Among those patients, resting PT increased (34.65 + 13.4 mA to 40.5 + 12.5 mA; P = .03), and acid infusion resulted in PT reductions. The authors concluded that patients with GERD and unexplained chest pain have esophageal pain hypersensitivity, which may be the result of central sensitization that is responsive to PPI treatment.
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