Wpływ chorób przełyku na przebieg choroby niedokrwiennej serca.

Exclusion of the ischemic heart disease is the first step in a differential diagnosis of chest pain. About 30% of patients hospitalized at the cardiological care units with suspicion of myocardial infarction have negative results of coronarography. Esophageal disorders are the most frequent causes of noncardiac chest pain. Additionally, esophageal disorders may induce chest pain by the cardioesophageal reflex. Gastroesophageal reflux, like Bernstein test, may induce angina pectoris resulting from vasoconstriction of coronary microcirculation, and cardiac arrhythmia. Abnormal vagovagal reflexes seem to play a crucial role in these disturbances. On the other hand, products of anoxygenic metabolism of cardiomyocytes due to coronary hypoperfusion may induce relaxation of the lower esophageal sphincter impairing one of the main antireflux mechanisms and leading to a vicious circle of events. Many medications used in the treatment for ischemic heart disease and arterial hypertension, as well as esophageal motility disorders, like nitrates and calcium channel blockers, have similar influence on the lower esophageal sphincter tension. Proper therapy of gastro-esophageal reflux disease and specific esophageal motility disorders may strongly affect the natural course of ischemic heart disease. [ABSTRACT FROM AUTHOR]