Rosztóczy András, Vass Andrea, Izbéki Ferenc, Nemes Attila, Rudas László, Csanády Miklós, Lonovics János, Forster Tamás, Wittmann Tibor
First Department of Medicine, Albert Szent-Györgyi Medical, Centre, University of Szeged, Hungary.
Int J Cardiol. 2007 May 16;118(1):62-8. doi: 10.1016/j.ijcard.2006.05.035. Epub 2006 Aug 7.
The aims of the study were to assess pathogenetic role of gastro-oesophageal reflux and the oesophago-cardiac reflex in subjects with chest pain. To evaluate the prevalence of gastro-oesophageal reflux disease and the oesophago-cardiac reflex in patients with different coronary artery diseases and in coronary spasm.
PATIENTS, METHODS: Fifty-one patients with chest pain were enrolled after detailed cardiologic evaluation including coronary angiography. The prevalence of gastrooesophageal reflux disease was established by symptom analysis, upper gastrointestinal endoscopy, 24-h oesophageal pH monitoring, and oesophageal manometry. The oesophago-cardiac reflex was established by oesophageal acid perfusion test (0.1 N HCl and 0.9% NaCl, 120-120 ml/10 min in a blinded manner) combined with transoesophageal Doppler echocardiographic coronary flow measurement in the left anterior descending artery.
Gastro-oesophageal reflux disease was established in 45% (23/51) of the patients. Oesophageal acid perfusion decreased the coronary flow velocity in 49% (25/51) of the patients indicating the presence of oesophago-cardiac reflex. Oesophago-cardiac reflex was present more frequently in patients with coronary spasm, than in patients with either epicardial coronary artery disease or microvascular coronary disease (p<0.02). Patients with oesophago-cardiac reflex had higher DeMeester scores, increased number of reflux episodes, fraction time below pH 4, and prolonged acid reflux episodes (p<0.05 for each parameter).
Gastro-oesophageal reflux disease is frequently established in patients with either epicardial or microvascular coronary artery disease or with coronary spasm. The oesophago-cardiac reflex was more frequently observed in patients with coronary spasm. The combination of oesophageal acid perfusion test and transoesophageal Doppler echocardiographic coronary flow measurement seems to be a useful method for the detection of this reflex. Patients with prolonged gastro-oesophageal acid reflux episodes, erosive oesophagitis and coronary spasm may be at higher risk for the development of linked-angina.
本研究的目的是评估胃食管反流和食管心脏反射在胸痛患者中的发病机制作用。评估不同冠状动脉疾病和冠状动脉痉挛患者中胃食管反流病和食管心脏反射的患病率。
患者、方法：51例胸痛患者在经过包括冠状动脉造影在内的详细心脏评估后入组。通过症状分析、上消化道内镜检查、24小时食管pH监测和食管测压确定胃食管反流病的患病率。通过食管酸灌注试验（0.1N盐酸和0.9%氯化钠，以盲法120 - 120ml/10分钟）结合经食管多普勒超声心动图测量左前降支冠状动脉血流来确定食管心脏反射。
45%（23/51）的患者确诊为胃食管反流病。食管酸灌注使49%（25/51）的患者冠状动脉血流速度降低，表明存在食管心脏反射。与患有心外膜冠状动脉疾病或微血管冠状动脉疾病的患者相比，冠状动脉痉挛患者中食管心脏反射的出现更为频繁（p<0.02）。有食管心脏反射的患者DeMeester评分更高，反流发作次数增加，pH值低于4的时间分数增加，酸反流发作时间延长（每个参数p<0.05）。
心外膜或微血管冠状动脉疾病或冠状动脉痉挛患者中常确诊为胃食管反流病。冠状动脉痉挛患者中更常观察到食管心脏反射。食管酸灌注试验和经食管多普勒超声心动图冠状动脉血流测量相结合似乎是检测这种反射的有用方法。胃食管酸反流发作时间延长、糜烂性食管炎和冠状动脉痉挛的患者可能发生关联性心绞痛的风险更高。
