Teragawa Hiroki, Oshita Chikage, Ueda Tomohiro
Department of Cardiovascular Medicine, JR Hiroshima Hospital, 3-1-36 Futabanosato, Higashi-ku, Hiroshima, 732-0057, Japan.
Heart Vessels. 2019 Oct;34(10):1631-1638. doi: 10.1007/s00380-019-01413-1. Epub 2019 Apr 16.
It is well known that patients with gastroesophageal reflux disease (GERD) experience GERD-related chest pain, but little is known about the relationship between GERD and coronary artery disease (CAD). We evaluated medical history of GERD in patients with suspected CAD and its association with types of CAD. We enrolled 236 patients who underwent coronary angiography (CAG). We assessed past medical history of each patient, making note of esophageal or stomach diseases such as GERD including reflux esophagitis and non-erosive reflux disease. The patients were divided into the following three subgroups based on the CAG results. Group I, patients with o-CAD (> 50% stenosis with ischemic findings, n = 141); Group II, patients with vasospastic angina (VSA, with positive spasm provocation test without organic coronary stenosis, n = 52); and Group III, patients without organic coronary stenosis or VSA (n = 43). Group I included more men than women (p < 0.001) and the frequencies of smoking, lipid disorders, and diabetes mellitus in this group were higher than those in the other groups (p < 0.01). The frequency of medical history of GERD was significantly higher in Group II (21%) than in Group I (3%) or Group III (7%, p < 0.0001). Logistic regression analysis showed that a medical history of GERD (OR 7.8; p < 0.01) was one of the factors associated with the presence of VSA. Our findings showed that a medical history of GERD was frequently observed in approximately one-fifth of patients with VSA, indicating that VSA may be present in patients with chest pain and a medical history of GERD.
众所周知，胃食管反流病（GERD）患者会经历与GERD相关的胸痛，但GERD与冠状动脉疾病（CAD）之间的关系却鲜为人知。我们评估了疑似CAD患者的GERD病史及其与CAD类型的关联。我们纳入了236例行冠状动脉造影（CAG）的患者。我们评估了每位患者的既往病史，记录食管或胃部疾病，如GERD，包括反流性食管炎和非糜烂性反流病。根据CAG结果，将患者分为以下三个亚组。第一组，梗阻性CAD患者（狭窄>50%且有缺血表现，n = 141）；第二组，血管痉挛性心绞痛（VSA）患者（痉挛激发试验阳性且无器质性冠状动脉狭窄，n = 52）；第三组，无器质性冠状动脉狭窄或VSA的患者（n = 43）。第一组男性多于女性（p < 0.001），该组吸烟、血脂异常和糖尿病的发生率高于其他组（p < 0.01）。GERD病史的发生率在第二组（21%）显著高于第一组（3%）或第三组（7%，p < 0.0001）。逻辑回归分析显示，GERD病史（OR 7.8；p < 0.01）是与VSA存在相关的因素之一。我们的研究结果表明，约五分之一的VSA患者经常有GERD病史，这表明胸痛且有GERD病史的患者可能存在VSA。
