Gastroesophageal reflux disease (GERD) may contribute to ischemic chest pain through acid-induced vasoconstriction and compromised coronary perfusion. In the September 2005, issue of the International Journal of Cardiology, Slawomir Dobrzycki and colleagues reported on the influence of omeprazole on ischemia in patients with GERD and coronary artery disease (CAD).
Patients (n = 50) with CAD underwent esophageal pH monitoring for 24 hours. During that time, the number of ST-segment depression episodes and the total duration of ischemic episodes, expressed as total ischemic burden (TIB), were assessed. Esophageal pH and the number of pathologic refluxes (PRs) were determined using pH-metry.
Patients fulfilling the GERD criteria (46%) received omeprazole therapy (20 mg bid) for 7 days. Of the 218 episodes of ST-segment depression, 45 (20.6%) were correlated with PRs. GERD patients had larger TIBs and more ST-segment depressions (P <.015 and P <.035, respectively). Omeprazole therapy reduced all parameters of esophageal pH monitoring (P <.0022), as well as the number of ST-segment depressions (P <.012) and TIBs (P <.05). Short-term omeprazole therapy restored normal esophageal pH and significantly reduced myocardial ischemia in patients with GERD and CAD.