Non-cardiac chest pain remains a widespread symptom especially in western countries with a significant economic burden. Patients with chest pain and abnormal electrocardiographic (ECG) but normal coronary angiogram (i.e. exclusion of coronary heart disease) is termed Cardiac syndrome X (CSX) and represents a specific subform of non-cardiac chest pain. While etiology of non-cardiac chest pain has been studied in several projects, it is unclear in what extent CSX is based on disorders of the upper gastrointestinal disorder (GI) tract.
A research group in Aachen, Germany, interviewed 119 patients with abnormal ECG findings after having received a normal coronary angiogram.
Their result will be published on November 14, 2008 in the World Journal of Gastroenterology. The research team led by Dr. Christoph. Dietrich from Medizinische Klinik II in Germany interviewed 119 patients with abnormal ECG findings after having received a normal coronary angiogram. Surprisingly, almost 30% of patients did not exhibit typical chest pain anymore as they had before the diagnostic procedure.
On the other hand, 97% of still symptomatic patients undergoing gastroenterological workup, had signs of acid-related disorders of the upper GI tract including reflux esophagitis and gastritis. Unlike in many patients with general non-cardiac chest pain, motility disorders of the esophagus do not seem to play a role in CSX. Treatment with proton pump inhibitors led to a significant improvement of symptoms with a considerable amount of symptom-free patients.
They concluded that in patients with CSX, acid-related disorders are frequent and respond very well to a long-term therapy with pantoprazole. This study emphasizes the need of further diagnostic work up for this special patient group which suffers from serious pain attacks mostly over a period of several years.
- Dietrich CG, Laupichler S, Stanzel S, Winograd R, Al-Taie O, Gartung C, Geier A. Origin of and therapeutic approach to cardiac syndrome X: Results of the proton pump inhibitor therapy for angina-like lingering pain trial (PITFALL trial). World J Gastroenterol, 2008; 14 (42): 6506-6512 [link]
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