GASTROESOPHAGEAL REFLUX IN PATIENTS WITH ANGIOGRAPHICALLY NORMAL CORONARY-ARTERIES - AN UNCOMMON CAUSE OF EXERTIONAL CHEST PAIN

Objectives-To investigate the association between exertional chest pai n and gastroesophageal reflux in patients with normal coronary angiogr ams and in controls by measuring oesophageal pH during treadmill exerc ise tests and to compare the results with routine ambulatory monitorin g. Design-Case control study. Setting-Tertiary referral cardiac unit. Patients-50 consecutive patients with chest pain and completely normal coronary angiograms and 16 controls with coronary artery stenoses. Ma in outcome measures-Episodes of acid reflux and chest pain during trea dmill exercise; a symptom index expressing the percentage of episodes of pain related to acid reflux during ambulatory monitoring. Results-F our (8%) patients and two (12%) controls had reflux during treadmill e xercise (NS). 32 (64%) and 16 (100%) reported chest pain, but only thr ee (6%) and two (12%) had coincident reflux (NS). Reflux was as freque nt before, during, and after treadmill exercise (five (8%) v six (9%) v two (3%)) in the 66 subjects; (NS). 19 (38%) patients and three (19% ) controls had abnormal reflux on ambulatory monitoring (NS). Eight (1 6%) and three (19%) had a symptom index > 50%, but six and two of thes e reported pain without coincident reflux during treadmill exercise. C onclusion-There are many potential causes of chest pain in patients wi th angiographically normal coronary arteries. Although gastroesophagea l reflux is commonly implicated and many patients have a high incidenc e of spontaneous reflux during ambulatory monitoring, it rarely occurs during exertion and the association with chest pain is poor.