Clinical trial: chest pain due to presumed gastro-oesophageal reflux in coronary artery disease - controlled study of lansoprazole versus placebo

Vivan Talwar (1) , Peter Wurm (2) , John Bankart (3) , Anthony Gershlik (4) , J S de Caestecker (2)

1 Gastroenterology
2 Digestive Diseases Centre
3 Department of Health Sciences [Leicester]
4 Department of Cardiology

Introduction: Gastro-oesophageal reflux (GOR) and coronary artery disease (CAD) commonly co-exist. CAD patients may mistake GOR-induced pain for cardiac pain or GOR might provoke angina. Hypothesis: GOR might contribute to nocturnal/rest chest pain among CAD patients. Methods: Double-blind placebo-controlled crossover study investigating effect of Lansoprazole on chest pain; 125 patients with angiographically proven CAD enrolled with at least one weekly episode of nocturnal/rest pain, randomized to Lansoprazole 30mg daily or placebo with crossover after 4 weeks. Symptoms recorded and QOL assessed by Nottingham Health Profile Questionnaire; ST segment depression episodes counted from 24hour electrocardiographic monitoring in final week of both periods. Statistical analysis: ANCOVA with period and carryover analysis. Results: 108 patients completed. There was a modest increase in pain-free days on Lansoprazole vs placebo (p<0.02), with fewer days with pain at rest (p<0.05) and at night (p<0.009) on Lansoprazole vs placebo, but no significant differences in ST segment depression episodes (p=0.64). There was a trend for reduction of the ‘physical pain' QOL domain. Conclusion: Among CAD patients, Lansoprazole modestly increases pain-free days and reduces rest/nocturnal pain. Since Lansoprazole did not affect ST segments, this may be by suppression of GOR-provoked pain misinterpreted as angina rather than acid-provoked ischaemia.

Mots clés: Medicine

Vivan Talwar, Peter Wurm, John Bankart, Anthony Gershlik, J S de Caestecker. Clinical trial: chest pain due to presumed gastro-oesophageal reflux in coronary artery disease - controlled study of lansoprazole versus placebo. Alimentary Pharmacology and Therapeutics, 2010, 32 (2), pp.191. ⟨10.1111/j.1365-2036.2010.04336.x⟩. ⟨hal-00552565⟩