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Clinical trial: chest pain caused by presumed gastro‐oesophageal reflux in coronary artery disease – controlled study of lansoprazole vs. placebo
Author(s) -
Talwar V.,
Wurm P.,
Bankart M. J. G.,
Gershlick A. H.,
De Caestecker J. S.
Publication year - 2010
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/j.1365-2036.2010.04336.x
Subject(s) - lansoprazole , medicine , chest pain , placebo , coronary artery disease , angina , nottingham health profile , crossover study , anesthesia , cardiology , gastroenterology , myocardial infarction , omeprazole , alternative medicine , pathology
Aliment Pharmacol Ther 2010; 32: 191–199 Summary Background Gastro‐oesophageal reflux (GER) and coronary artery disease commonly co‐exist. Coronary artery disease patients may mistake GER‐induced pain for cardiac pain or GER might provoke angina. Aim To investigate if GER might contribute to nocturnal/rest chest pain among coronary artery disease patients. Methods Double‐blind placebo‐controlled crossover study investigating effect of lansoprazole on chest pain; 125 patients with angiographically proven coronary artery disease enrolled with at least one weekly episode of nocturnal/rest pain, randomized to lansoprazole 30 mg daily or placebo with crossover after 4 weeks. Symptoms recorded and QOL assessed by Nottingham Health Profile Questionnaire; ST segment depression episodes counted from 24 h electrocardiographic monitoring in final week of both periods. Statistical analysis: ANCOVA with period and carryover analysis. Results In all, 108 patients completed the study. 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 in the ‘physical pain’ QOL domain. Conclusions Among coronary artery disease patients, lansoprazole modestly increases pain‐free days and reduces rest/nocturnal pain. As lansoprazole did not affect ST segments, this may be by suppression of GER‐provoked pain misinterpreted as angina, rather than acid‐provoked ischaemia.