Gastroesophageal Reflux Disease and Coronary Heart Disease - From Pathophysiology to Treatment Controversies

Chest pain experienced by patients with coronary heart disease (CHD) can be of non-cardiac origin, and symptoms frequently related to gastro-oesophageal aetiologies. Gastro-oesophageal reflux disease (GERD) and CHD can cause chest pain and frequently co-exist. It seems that GERD is a frequent condition in patients with CHD. Coexistence of GERD may predispose to the myocardial ischemia. In humans, chemical, electrical, and mechanical stimulation of the oesophagus modifies the sympatho-vagal balance. Gastro-oesophageal reflux disease may cause the shift of sympatho-vagal balance towards its parasympathetic component. One of potential mechanisms explaining the influence of oesophageal disturbance on the appearance of coronary hypo-perfusion may be their common neurological control of the functions, which include oesophageal-cardiac reflex. Short-term proton pump inhibitors therapy in patients with GERD that restores normal oesophageal pH significantly reduces myocardial ischemia, possibly due to elimination of acid-derived oesophageal-cardiac reflex compromising coronary perfusion. Long-term proton pump inhibitors interfere with the clearance of asymmetrical dimethyl-arginine, the endogenous antagonist of nitric oxide synthase. However, mechanisms by which the proton pump inhibitors may increase the risk of major adverse cardiovascular events in CHD patients are still controversial.