Helicobacter pylori infection, esophagitis severity, and myocardial electrical instability in patients with coronary heart disease and gastroesophageal reflux disease

Aim. To investigate correlations of gastro-esophageal reflux (GER), Helicobacter pylori (HP) infection, and myocardial electric instability markers in patients with coronary heart disease (CHD) and GER disease (GERD). Material and methods. In total, 225 patients were examined: 67 individuals with CHD and GERD (main group), and two comparison groups: 72 CHD patients, and 86 GERD subjects. Markers of myocardial electric instability included: duration and asynchrony of repolarization. To assess GER influence on heart function, Bernstein test was used, combined with 24-hour electrocardiogram (ECG) monitoring. GERD was diagnosed by endoscopy data. GERD with catarrhal or erosive reflux-esophagitis (CRE, ERE) were registered. HP infection was diagnosed by polymerase chain reaction (PCR) and histobacterioscopy of gastric mucosa bioptates. Results. In CHD and GERD patients, ST segment ischemic changes, ventricular extrasystolia (VE) were registered more often. With associated ERE, these heart function disturbances were more frequent than in CRE. In patients with combined pathology, high HP invasion of gastric mucosa was significantly associated with greater duration and asynchrony of repolarization. Myocardial repolarization duration was independently linked to CHD exacerbation, red blood cell sedimentation rate, and HP dissemination of gastric mucosa. Inhomogeneity of myocardial repolarization was linked to myocardial infarction in anamnesis and RE severity. Factors affecting heart function during Bernstein test, HP infection, increased level of C-reactive protein, and instable CHD were independent predictors of RE development in imitated GER. Conclusion. In patients with CHD and GERD, myocardial electric instability was linked to RE severity and HP status.

1. Aruin L.I., Kapuller L.L., Isakov A.A. Morfologicheskaya diagnostika boleznei zheludka i kishechnika. Moskva 1998; 483 s.

2. Baevskii R.M., Ivanov G.G. Variabel'nost' serdechnogo ritma: teoreticheskie aspekty i vozmozhnosti klinicheskogo primeneniya. Ul'trazvuk funkts diagn 2001; 3: 108-27.

3. Baevskii R.M., Volkov Yu.N., Nidekker I.G. Statisticheskii, korrelyatsionnyi i spektral'nyi analiz pul'sa v fiziologii i klinike. Sbornik. Matematicheskie metody analiza serdechnogo ritma. Moskva 1986; 51-61.

4. Bitti A.D. Diagnosticheskie testy v gastroenterologii. Moskva 1995; 15-6.

5. Grinevich V.B., Sablin O.A., Bogdanov I.V. Gastroezofageal'naya reflyuksnaya bolezn' i pishchevod Barreta. Sankt-Peterburg 2001; 29 s.

6. Ivashkin V.T., Trukhmanov A.S. Bolezni pishchevoda. Moskva 2000; 179 s.

7. Isakov V.A., Domaradskii I.V. Khelikobakterioz. Moskva 2003; 412 s.

8. Krylov A.A. K probleme sochetaemosti zabolevanii. Kli med 2000; 1: 56-8.

9. Lazebnik L.B., Drozdov V.N. Genez polimorbidnosti. Klin gerontol 2001; 1-2: 3-5.

10. Nikitin Yu.P., Kuznetsov A.A. Dispersiya intervala QT. Kardiologiya 1998; 5: 58-62.

11. Oganov R.G., Maslennikova G.Ya. Smertnost' ot serdechno-sosudistykh i drugikh khronicheskikh neinfektsionnykh zabolevanii sredi trudosposobnogo naseleniya Rossii. Kardiovask ter profil 2002; 3: 4-12.

12. Storonova O.A., Trukhmanov A.S., Drapkina O.M., Ivashkin V.T. Ezofagogennye i koronarogennye boli v grudnoi kletke: problemy differentsial'noi diagnostiki. Ross zh gastroenterol, gepatol, koloproktol 2002; 1: 68-72.

13. Taranchenko Yu.V., Zvenigorodskaya L.A. Differentsial'naya diagnostika zagrudinnykh bolei pri sochetanii gastroezofageal'noi reflyuksnoi bolezni s ishemicheskoi bolezn'yu serdtsa. Cons med. Prilozhenie 2002; 6: 495-8.

14. Shkol'nikova M.A. Sindrom udlinennogo intervala QT. Moskva 2001; 46-80.

15. El'shtein N.V. Mnozhestvennost' zabolevanii kak odna iz klyuchevykh problem sovremennoi gastroenterologii. Gastrobyulleten' 2001; 2-3: 99.

16. Bercik P, Verdu E, Armstrong D. Reflux esophagitis and N. Pylori. Gastroenterology 1997; 113: 2020-1.

17. Birnie DH, Holme ER, McKay IC, et al. Association between antibodies to heat shock protein 65 and coronary atherosclerosis. Possible mechanism of action Helicobacter pylori and other bacterial infections in increasing cardiovascular risk. Eur Heart J 1998; 19: 387-94.

18. Chauhan A, Petch MC, Schofield PM. Cardio-oesophageal reflex in humans as a mechanism for «linked angina». Eur Heart J 1996; 17: 407-13.

19. Befrits R, Sjostedt S, Ward M, et al. Curing Helicobacter pylori infection in patients with duodenal ulcer does not provoke gastroesophageal reflux disease. Helicobacter 2000; 5: 202-5.

20. Davies HA, Rush EN, Lewis MJ, et al. Esophageal stimulation lowers exertional angina threshold. Lancet 1995; 1: 111.

21. Day CP, McComb JM, Campbell RWF. QT Dispersion: an indication of Arrhythmia Risk in patients with Long QT Intervals. Br Heart J 1999; 63: 342-4.

22. Kowalski M, Konturek PC, Piemazek P, et al. Prevalence of Helicobacter pylori infection m coronary artery disease and effect of its eradication on coronary lumen reduction after percutaneous coronary angioplasty. Dig Liver Dis 2001; 33: 222-9.

23. Pace F, Bianchi Porro G. Gastrooesophageal reflux and Helicobacter pylori. Dig Liver Dis 2000; 32: 202-6.

24. Richter JE. Atypical Presentation of Gastroesophageal Reflux Disease. Clinical perspectives in Gastroenterology 1996; 34: 7-10.