What is the etiology of cardiac syndrome X?

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.

Reference: 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 http://www.wjgnet.com/1007-9327/14/6506.asp

Correspondence to: Andreas Geier, MD, Division of Gastroenterology and Hepatology, University Hospital Zurich, Rämistr. 100, Zurich 8091, Switzerland. andreas.geier@usz.ch Telephone: +41-44-2552259 Fax: +41-44-2554503

World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H pylori infection and provides a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health. ISI JCR 2003-2000 IF: 3.318, 2.532, 1.445 and 0.993. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th day of every month. WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the name of China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.

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