Coexistence of proangiogenic potential and increased MMP-9, TIMP-1, and TIMP-2 levels in the plasma of patients with critical limb ischemia.

The objective of this study was to assess the angiogenic potential expressed as a quotient of vascular endothelial growth factor A (VEGF-A), as an indicator of proangiogenic activity, and the circulating receptors (soluble VEGF receptor protein R1 (sVEGFR-1) and sVEGFR-2), as indicators of the effect of angiogenic inhibition, depending on the concentrations of matrix metalloproteinase 2 (MMP-2) and MMP-9 and their tissue inhibitor 1 (TIMP-1) and TIMP-2 in the plasma of patients with lower extremity artery disease (LEAD). These blood parameters in patients with intermittent claudication (IC) and critical limb ischemia (CLI) were compared for select clinical and biochemical features. Stimulation of angiogenesis in the plasma of individuals with LEAD was evident as indicated by the significant increase in VEGF-A concentration along with reduced inhibition depending on circulating receptors sVEGFR-1 and sVEGFR-2. Critical ischemia was associated with higher VEGF-A, MMP-9, TIMP-1, and TIMP-2 concentrations than in the case of IC.

Overweight and obesity versus concentrations of VEGF-A, sVEGFR-1, and sVEGFR-2 in plasma of patients with lower limb chronic ischemia.

OBJECTIVE: Being overweight or obese comprises a significant risk factor for atherosclerosis. Fat tissue also generates factors stimulating angiogenesis, the process by which new blood vessels form. The purpose of this paper is to assess concentrations of the vascular endothelial growth factor A (VEGF-A) and its soluble type-1 and type-2 receptors (sVEGFR-1 and sVEGFR-2) in plasma of patients with peripheral arterial disease (PAD) depending on the level of nutrition according to body mass index (BMI). METHODS: The study group included patients suffering from symptomatic PAD (n=46) in Fontaine classes IIa-IV without any history of neoplastic disease and who have a normal BMI (n=15), are overweight (n=21) or are obese (n=10). The control group (n=30) consisted of healthy non-smoking volunteers who were neither overweight nor obese. Venous blood plasma samples were collected from both groups at rest in the morning to determine plasma concentrations of VEGF-A, sVEGFR-1, and sVEGFR-2 using the enzyme-linked immunosorbent assay (ELISA) method. RESULTS: The group of patients with PAD co-existent with being overweight or obese tended to have higher mean concentration levels of VEGF-A and sVEGFR-2 when compared with patients suffering from PAD with normal BMI. A statistically significant positive correlation was obtained between BMI and average plasma concentrations of sVEGFR-2 (R=0.37, P=0.0103). However, no significant correlation was noticed between BMI and VEGF-A or sVEGFR-1 concentrations. CONCLUSIONS: A positive correlation determined between the level of antiangiogenic factor and BMI value may be indicative of the linearly growing prevalence of some antiangiogenic factors in patients with metabolic disorders, which may be one of numerous factors contributing to incomplete efficiency of collateral circulation development in patients with PAD.

Impact of type 2 diabetes on the plasma levels of vascular endothelial growth factor and its soluble receptors type 1 and type 2 in patients with peripheral arterial disease.

OBJECTIVE: Type 2 diabetes coexistent with lower extremity artery disease (peripheral arterial disease (PAD)) can be observed in numerous patients. The mechanism compensating for ischemia and contributing to healing is angiogenesis-the process of forming new blood vessels. The purpose of this study was to assess the likely impact of type 2 diabetes on the plasma levels of proangiogenic factor (vascular endothelial growth factor A (VEGF-A)) and angiogenesis inhibitors (soluble VEGF receptors type 1 and type 2 (sVEGFR-1 and sVEGFR-2)) in patients with PAD. METHODS: Among 46 patients with PAD under pharmacological therapy (non-invasive), we identified, based on medical history, a subgroup with coexistent type 2 diabetes (PAD-DM2+, n=15) and without diabetes (PAD-DM2-, n=31). The control group consisted of 30 healthy subjects. Plasma levels of VEGF-A, sVEGFR-1, and sVEGFR-2 were measured using the enzyme-linked immunosorbent assay (ELISA) method. RESULTS: The subgroups of PAD-DM2+ and PAD-DM2- revealed significantly higher concentrations of VEGF-A (P=0.000 007 and P=0.000 000 1, respectively) and significantly lower sVEGFR-2 levels (P=0.02 and P=0.000 01, respectively), when compared with the control group. Patients with PAD and coexistent diabetes tended to have a lower level of VEGF-A and higher levels of sVEGFR-1 and sVEGFR-2 comparable with non-diabetic patients. CONCLUSIONS: The coexistence of type 2 diabetes and PAD is demonstrated by a tendency to a lower plasma level of proangiogenic factor (VEGF-A) and higher levels of angiogenesis inhibitors (sVEGFR-1 and sVEGFR-2) at the same time. Regardless of the coexistence of type 2 diabetes, hypoxia appears to be a crucial factor stimulating the processes of angiogenesis in PAD patients comparable with healthy individuals, whereas hyperglycemia may have a negative impact on angiogenesis in lower limbs.

Improvement in health-related quality of life after therapy with omeprazole in patients with coronary artery disease and recurrent angina-like chest pain. A double-blind, placebo-controlled trial of the SF-36 survey.

BACKGROUND: Many patients with coronary artery disease (CAD) have overlapping gastroenterological causes of recurrent chest pain, mainly due to gastroesophageal reflux (GER) and aspirin-induced gastrointestinal tract damage. These symptoms can be alleviated by proton pump inhibitors (PPIs). The study addressed whether omeprazole treatment also affects general health-related quality of life (HRQL) in patients with CAD. STUDY: 48 patients with more than 50% narrowing of the coronary arteries on angiography without clinically overt gastrointestinal symptoms were studied. In a double-blind, placebo-controlled, cross-over study design, patients were randomized to take omeprazole 20 mg bid or a placebo for two weeks, and then crossed over to the other study arm. The SF-36 questionnaire was completed before treatment and again after two weeks of therapy. RESULTS: Patients treated with omeprazole in comparison to the subjects taking the placebo had significantly greater values for the SF-36 survey (which relates to both physical and mental health), as well as for bodily pain, general health perception, and physical health. In comparison to the baseline values, therapy with omeprazole led to a significant increase in the three summarized health components: total SF-36; physical and mental health; and in the following detailed health concept scores: physical functioning, limitations due to physical health problems, bodily pain and emotional well-being. CONCLUSIONS: A double dose of omeprazole improved the general HRQL in patients with CAD without severe gastrointestinal symptoms more effectively than the placebo.

Treatment with double dose of omeprazole increases ß-endorphin plasma level in patients with coronary artery disease.

INTRODUCTION: The proton pump inhibitor empirical trial, besides the analysis of symptoms, is the main method in the diagnosis of gastro-oesophageal reflux disease-related chest pain. ß-Endorphin acts as an endogenous analgesia system. The aim of the study was verify whether ß-endorphin plasma level is affected by omeprazole administration and influences the severity of anginal symptoms and outcome of the "omeprazole test" in patients with coronary artery disease (CAD) and chest pain of suspected non-cardiac origin. MATERIAL AND METHODS: Omeprazole was administered to 48 patients with CAD in a randomized, placebo-controlled, crossover study design. At the beginning of the study, and again after the 14-day omeprazole and placebo treatment, the ß-endorphin plasma concentration was determined. RESULTS: The level of plasma ß-endorphin after the administration of omeprazole was significantly greater than at the start of the study and following the placebo. Responders to omeprazole had an average lower ß-endorphin plasma concentration than subjects who failed to respond to this therapy. Subjects with symptoms in class III (according to the Canadian Cardiovascular Society classification) after omeprazole administration had a greater ß-endorphin plasma level than subjects in class II for anginal symptom severity. CONCLUSIONS: Fourteen-day therapy with a double omeprazole dose significantly increases the ß-endorphin plasma concentration in patients with CAD. Circulating ß-endorphin does not seem to be involved in the mechanism for the "omeprazole test" outcome, although an individually different effect on pain threshold cannot be excluded.

[Pheochromocytoma--a disease which is worth to keep in mind]. / Guz chromochlonny nadnercza--choroba, o której warto pamietac.

The case of 25 years old male patient with symptoms of hypertensive storm in the course of pheochromocytoma was presented. For some years he had been suffering from moderate increase in arterial blood pressure whose secondary cause was not suspected by physicians examining this patient. In presented case the course of pheochromocytoma has special characteristics, such as: clinical presentation in young age, the course alternate between periods of hypertension and phases of normal blood pressure, physical signs of Marfan's syndrome, increase of troponin level within hypertensive storm, and attributes of malignant hypertension presented as transient proteinuria and glycosuria within normoglycemia.

[Systemic blood pressure in oculist practice--chosen aspects]. / Systemowe cisnienie tetnicze w praktyce lekarza okulisty--wybrane aspekty.

Blood pressure have the dual importance in eye-doctor practice. Its high values, leading to injury of vascular wall, cause its stiffness, narrowing and eye-ball perfusion disturbance. On the other hand, in case of impaired eye-ball circulation autoregulation, recurrent episodes of low blood pressure may lead to processes of ischemia-reperfusion with oxygen free radicals overproduction and retinal ganglion cells apoptosis. It seems, that complex control of the atherosclerosis risk factors level as well as use of drugs favourable affecting endothelial function (angiotensin-converting enzyme inhibitor, statins), may decrease an eye-ball vasculature injury and make it less susceptible to blood pressure variation. This suggests acceptance of atherosclerosis risk factors, especially hypertension, as a predictor of early glaucomatous optic neuropathy on the "pre-perimetric" stage of disease.

The effect of double dose of omeprazole on the course of angina pectoris and treadmill stress test in patients with coronary artery disease--a randomised, double-blind, placebo controlled, crossover trial.

BACKGROUND: Gastroesophageal reflux (GER) and coronary artery disease (CAD) frequently overlap, making the proper diagnosis of chest pain more difficult. GER symptoms may mistake anginal chest pain, and oesophageal acidification may induce myocardial ischaemia both in the rest and in the effort. Increase of oesophageal pH should prevent these conditions. AIM: To estimate the effect of double omeprazole dose on the course of angina pectoris and treadmill stress test in patients with coronary artery disease (CAD), using double-blind, crossover randomised, placebo-controlled study design. METHODS: We studied 48 patients with angina pectoris symptoms and significant narrowing of coronary vessels in angiography. After baseline examination and treadmill stress test all subjects were randomised to treat either with omeprazole (20 mg b.i.d.) or placebo for 14 days, using a double-blind, crossover placebo controlled design. RESULTS: Seventeen (35%) subjects reported more than by half decrease in symptoms severity after omeprazole and 6 (12%) after placebo (p=0,01). Omeprazole significantly decreased the number of chest pain episodes and number of nitroglycerin doses taken in the second week of both study phases, as well as the percentage of subjects with significant decrease of ST interval during the stress test (64% vs. 73%, p<0,05). However majority of other stress test parameters (i.e. test duration, DUKE index) have improved both after omeprazole and placebo administration (by 9-38%). CONCLUSION: Double dose of omeprazole significantly decreased symptoms severity in 35% of patients with CAD, as well as frequency of some electrocardiographic signs of myocardial ischaemia during stress test.

[Association of temperament, character and depressive symptoms with clinical features of the ischaemic heart disease]. / Zwiazek cech temperamentu i charakteru oraz objawów depresji z obrazem klinicznym choroby niedokrwiennej serca.

UNLABELLED: The aim of this study was to assess the associations between temperament and character, depressive symptoms and the intensity and the course of ischaemic heart disease. MATERIAL AND METHODS: 42 patients with ischaemic heart disease, aged 37-65 years, meeting the ICD-10 diagnostic criteria, participated in this study. The evaluation of temperament and character was performed using Cloninger's Temperament and Character Inventory (TCI), and the intensity of depressive symptoms was assessed with Beck Depression Index (BDI). The clinical features of the illness were evaluated by structuralized interview. RESULTS: Subjects with ischaemic heart disease presented significant severity of depresive symptoms on BDI (mean 19.9 points). Patients with higher intensity of ischaemic heart disease symptoms (with myocardial infraction, treated with interventional treatment) presented significantly greater severity of depression. Moreover these subjects were characterized with the specific features of temperament and character: higher level of harm avoidance and lower level of reward dependence. The longer duration of the illness was associated with the lower scores of the character trait--the ability to self-transcendence. CONCLUSIONS: The obtained results may indicate, that the worse course of ischaemic heart disease and intensity of the illness are associated with the higher severity of depressive symptoms and with specific traits of temperament and character.

[Factors affecting the concentration of plasma tumour necrosis factor alpha (TNF-alpha) and liver function tests values in alcohol dependent males after alcohol drinking cessation]. / Czynniki wplywajace na stezenie czynnika martwicy guza (TNF-alfa) i poziom prób watrobowych w surowicy u mezczyzn uzaleznionych od alkoholu po jego odstawieniu.

AIMS: In our work, the factors affecting the plasma level of cytokine, tumour necrosis factor (TNF-alpha) and liver function tests values in alcohol dependent males after alcohol abuse period were analysed. METHODS: We studied forty-seven alcoholics, without severe liver disease, who were abstinent no longer than 14 days before the study beginning. In all 24-h gastric pH-metry, endoscopy, serum liver function tests and TNF-alfa concentration were estimated. RESULTS: The amount of alcohol drunk within 90 days before the study start correlated with plasma activity of AST, ALT and GGT. The plasma presence of TNF-alpha in 26 subjects was found, but in 21 patients this cytokine level was lower than the method sensitivity (< 0.05 pg/ ml). Using the step-wise method of multiple regression we found, that TNF-alfa level at the study commencement was determined by history of delirium tremens, Michigan Alcoholism Screening Test score, length of alcohol dependence, ALT activity, % of total monitoring time with gastric pH >3, intensity of antral H. pylori colonisation and number of standard drinks drunk for 90 days before the study start (ns). Similar factors determined liver function tests values variance. CONCLUSION: Values of TNF-alpha and liver function tests two weeks after alcohol withdrawal were independently determined by gastric pH, H.pylori infection and smoking, which suggests their potential synergism with a hepatotoxic effect of alcohol drinking.

Differences in esophageal corpus motility in patients with pathological and non-pathological gastroesophageal reflux.

BACKGROUND: First- and second-order esophageal contractions are important factors responsible for esophageal clearance of refluxed gastric content. The aim of this study was to estimate the influence of acid reflux on second-order esophageal peristalsis. MATERIAL/METHODS: Simultaneous 24-h esophageal pH-metry and 24-h motility monitoring was performed in 213 patients with non-cardiac chest pain. Pathological gastroesophageal acid reflux (pGER) was defined as pH <4 for more than 4.5% of the total monitoring time. RESULTS: The group of pGER patients (n=65, 31%) had a lower percentage of complete and effective peristalsis, a higher percentage of incomplete peristalsis, and a lower mean contraction amplitude than the group of patients with normal esophageal acid exposure (nGER). Analysis of motility parameters in three periods, i.e. during acid reflux and 2 min before and 10 min after episodes (second-order peristalsis), showed that the pGER group had a lower percentage of effective peristalsis (20.6 +/- 13.3 vs. 29.6 +/- 16.2%, p = 0.002) and a higher percentage of ineffective peristalsis both during and after acid reflux, a lower mean contraction amplitude (56.5 +/- 30.3 vs. 70.0 +/- 32.8 mmHg, p=0.025), and a lower contraction frequency during acid reflux (1.6 +/- 0.7 vs. 2.6 +/- 3.1/min, p=0.001) and 10 min after (1.9 +/- 1.9 vs. 20.6 +/- 30.2/min, p=0.002), which indicated a lack of esophageal peristalsis acceleration after acid reflux in the pGER group. CONCLUSIONS: (1) pGER patients had ineffective esophageal peristalsis more frequently than nGER patients. (2) Impaired second-order peristalsis in pGER patients may be an important factor determining prolonged exposure of the esophageal mucosa to gastric content in addition to lower esophageal sphincter function.

[Gastroesophageal reflux disease and coronary heart disease--coexistence or interrelationship?]. / Choroba refluksowa przelyku a choroba wiencowa-- wspólistnienie czy zaleznosc?

There is the normal coronary artery appearance in 20-30% of coronarographies, made in patients with chest pain and/or positive noninvasive cardiological tests. The simple explanation of this fact is the presence of diseases which may affect coronary perfusion via mechanism independent to the diameter of main coronary arteries. One of them is gastroesophageal reflux disease (GERD). The presence of GERD symptoms in general population concerns about 30-40% of individuals, while non-physiological reflux is stated in 50-65-85% of patients with coronary heart disease (CHD). That means, that GERD is twice more frequent in patients with CHD than in general population. One explanation of the increased frequency of gastroesophageal reflux appearance in patients with CHD is the adverse effect of drugs used in treatment of cardiological diseases. Morover, one of potential mechanisms explaining the influence of esophagal disturbance on the appearance of coronary hipoperfusion may be their common neurological control of the functions. There are three aspects of it: vagal reflexes (esophageal-cardiac reflex), the disturbances of autonomic nervous system balance and changes in visceral pain perception threshold. Visceral reflex can combine GERD and CHD with mechanism of vicious circle: acid gastroesophageal reflux via vagal reflex may cause coronary hipoperfusion, and the products of anaerobic metabolism of cardiomyocytes may cause relaxation of lower esophagus sphincter, facilitating reflux. Additional mechanism connecting GERD and CHD is inflammation caused by Helicobacter pylori infection. The relationship between digestive tract pathology and evolution, as well as progression and complications of atherosclerosis together with similarity of clinical presentation imply the necessity of precise diagnosis of chest pain causes and caution in interpretation of laboratory examination results.

[The relationship between oesophageal and gastric pH during 24-hours pH-metry in patients diagnosed with atypical chest pain]. / Zaleznosc pH przelykowego od pH zoladkowego w 24-godzinnej pH-metrii u pacjentów z atypowym bólem w klatce piersiowej.

UNLABELLED: Gastric secretion is the only source of hydrochloric acid influencing oesophageal and extraesophageal symptoms in patients with gastroesophageal reflux disease (GERD). The aim of this study was to determine the relationships between gastric and oesophageal pH estimated by 24-hours pH-metry. PATIENTS AND METHODS: We studied 93 men suffering from atypical chest pain. In all endoscopy with mucosa biopsy and simultaneous gastric and oesophageal 24-hours pH-metry using two-channel antimony probe with 15 cm distance of measurement ducts were performed. RESULTS: Among studied patients 24 (26%) had pathological gastroesophageal acid reflux in pH-metry (above 4.5% of monitoring time with oesophageal pH<4). This patients group had higher percentage of monitoring time with gastric pH<4. but only with borderline statistical significance. We did not not find significant differences in values of gastric and oesophageal pH-metry parameters between patients group divided in relation to presence of endoscopic and histologic features of oesophagitis. We found only some significant, but weak correlations between gastric and oesophageal pH. CONCLUSION: Only weak relationship occurring between gastric and oesophageal pH suggests more important role of some other factors in pathogenesis of gastroesophageal reflux and oesophageal mucosa injury.

[Gastroesophageal acid reflux as a causative factor of paroxysmal atrial fibrillation]. / Napadowe migotanie przedsionków. Kwasny refluks zoladkowo-przelykowy jako czynnik wyzwalajacy.

We present a case of a patient with very frequent episodes of paroxysmal atrial fibrillation (AF) who, besides hypertension and well-controlled post-amiodarone thyreotoxicosis, had no other potential causes of AF. Because of symptoms of gastroesophageal acid reflux, the patient was treated with omeprazole which significantly reduced the frequency of AF episodes. Next, the patient underwent anti-reflux surgery and has now only sporadic recurrences of AF. Our observations suggest that gastroesophageal acid reflux may be a triggering factor of AF.

[The effect of hypolipemic therapy with diet and simvastatin on the course of angina pectoris and the results of exercise stress test in patients with coronary artery disease]. / Wplyw leczenia hipolipemizujaego dieta i simwastatyn na przebieg dusznicy bolesnej i wyniki elektrokardiograficznej próby wysilkowej u pacjentów z choroba niedokrwienna serca.

UNLABELLED: Statins are the multi-directorial acting drugs in atherosclerosis prevention, which decrease the overall and cardiovascular mortality. The aim of this study was to estimate the effect of six-month long hypolipemic therapy with diet and 20 mg of simvastatin on clinical intensity of angina pectoris and the course of exercise stress test. PATIENTS AND METHODS: We studied 44 patients with typical anginal chest pain. In all blood sampling and treadmill stress test were made, and next in all hypolipemic diet and simvastatin 20 mg were recommended. After four weeks and six months of treatment clinical assessment and exercise test were made. RESULTS: After four weeks and six month long observation period the decrease of total and LDL cholesterol, triglycerides and fibrinogen were found. Moreover, we have observed the improvement in frequency of anginal symptoms, their intensity in CCS classification and number of nitroglycerin tablets taken per week. The course of exercise test was also ameliorated: the percentage of patients, in whom stress test was finished because of chest pain was decreased, time of chest pain duration after exercise cessation was shorter, the percentage of patients with significant ST interval depression diminished, maximal ST interval depression as well as the time of significant ST interval depression duration also decreased. Although improvement in values of mentioned parameters, after six months long therapy with simvastatin the percentage of patients with Duke's treadmill score value showing intermediate cardiovascular risk (between -10 and +4) increased. In conclusion, therapy with hypolipemic diet and simvastatin already after four weeks decreased plasma lipids and fibrinogen levels and improved the course of angina pectoris and exercise stress test, what suggested its effectiveness not only as the treatment improving atherosclerosis risk factors, but also with prompt and clinical important effect ameliorating the handicapped coronary reserve.

[Influence of Helicobacter pylori infection on the results of 24-hour gastric pH-metry in patients diagnosed because of atypical chest pain]. / Wplyw zakazenia Helicobacter pylori na wyniki 24-godzinnej pH-metrii zoladkowej u pacjentów diagnozowanych z powodu nietypowego bólu w klatce piersiowej.

UNLABELLED: Changes in gastric acidity induced by Helicobacter pylori (Hp) infection, may influence intensity of symptoms in patients diagnosed because of chest pain. The aim of this study was to compare the results of 24-hours gastric pH-metry in patients suffering from atypical chest pain infected and not-infected by Hp. PATIENTS AND METHODS: In 99 men diagnosed because of atypical chest pain performed were: interview, physical examination, gastroduodenoscopy with musoca biopsy from gastric corpus and antrum, as well as 24-hour gastric pH-metry. Hp infection was diagnosed on the basis of positive urease test or/and histologic examination. RESULTS: 78% of subjects were infected by Hp. Hp positive patients had lower total and night-time percentage of monitoring time with gastric pH<4 and greater with pH > 6. Patients with isolated antral Hp colonization and subjects with pangastritis didn't differ in respect to gastric pH-metry parameters values. However in patients, with Hp colonization only in gastric corpus the time with gastric pH < 4 was shorter and with pH > 6 longer than in other groups. CONCLUSIONS: Hp-positive patients with atypical chest pain had lower gastric acidity than Hp-negative subjects. In patients with corporal Hp gastric mucosa colonization higher intra-gastric pH was observed than in the rest of patients.

Improvement in clinical course and laryngeal appearance in selected patients with chronic laryngitis after eight weeks of therapy with rabeprazole.

BACKGROUND: One well-known extraesophageal manifestation of gastroesophageal reflux disease (GERD) is chronic laryngitis. The aim of this study was to estimate the efficiency of eight weeks of treatment with the PPI rabeprazole in a selected group of patients with chronic idiopathic laryngitis without typical GERD symptoms. MATERIAL/METHODS: Seventeen patients (nine men and eight women) aged 35-72 years, with long histories (0.5 to 6 years) of chronic idiopathic laryngitis were included in the study. Larynx appearance was estimated by laryngostroboscopy. This examination, as well as interview and physical examination were performed in all patients at the start of the study and after 8 weeks of treatment with 20 mg rabeprazole taken orally twice a day. RESULTS: There was remarkably good therapeutic outcome, clinical symptoms such as hoarseness and pharyngeal pain resolved, respectively, in 68.7 and 78.5% of patients and laryngeal signs in 50-80%, except for weak tension of the vocal cords which was observed in 12 patients at the start and end of the study. CONCLUSIONS: Treatment with a proton pump inhibitor can be considered as a first-line diagnostic and therapeutic method in patients with idiopathic chronic laryngitis. Weak tension of vocal cords was often seen in these patients and persisted after the 8-week-long treatment.

Suppression of gastric acid production may improve the course of angina pectoris and the results of treadmill stress test in patients with coronary artery disease.

BACKGROUND: Coronary artery disease (CAD) and gastro-esophageal reflux disease (GERD) often coexist in the same patients. The aim of this study was to estimate the effects of gastric acid output suppression with rabeprazole on course of angina pectoris and results of the treadmill stress test in patients with CAD. MATERIAL/METHODS: We studied 34 patients with stable angina pectoris. In all subjects a medical history, a physical examination, and a stress test were performed at the beginning of the study and after two weeks of add-on rabeprazole therapy (20 mg b.i.d.). RESULTS: Rabeprazole therapy significantly improved the outcome of the stress test in 27 patients (79%), prolonging mean stress exercise time (449+/-147 vs. 489+/-156s, p=0.027) and exercise time, leading to a maximum ST interval depression (360+/-167 vs. 467+/-148s, p=0.001), and also decreasing ST interval depression delta (1.9+/-1.1 vs. 1.5+/-0.9; p=0.013). CONCLUSIONS: In 79% of our study subjects, rabeprazole improved stress test results in CAD patients, which implies that at least some of their symptoms were related to GERD. A proton pump inhibitor exerted a favorable effect on the frequency of angina-like chest pain and the results of the treadmill stress test.

[Effect of Helicobacter pylori infection on the gastroesophageal reflux in patients with atypical chest pain]. / Wplyw zakazenia Helicobacter pylori na wielkosc refluksu zoladkowo-przelykowego u pacjentów diagnozowanych z powodu nietypowych bólów w klatce piersiowej.

UNLABELLED: The role of Helicobacter pylori (Hp) infection in the course of gastroesophageal reflux disease (GERD) is still controversial. The aim of this study was to compare the results of endoscopic, histologic and pH-metric examinations of esophagus in patients diagnosed because of atypical chest pain, infected and not-infected by Hp. In 172 patients diagnosed because of atypical chest pain were made: interview, physical examination, gastroduodenoscopy with esophageal and gastric mucosa biopsy as well as esophageal pH-metry. Hp infection was diagnosed on the basis of positive urease test or/and histologic examination. In 49 (28%) subjects pathological gastroesophageal acid reflux was diagnosed (above 4.5% of monitoring time with pH < 4). Percentage of Hp infected patients among subjects with pathological (69%) and not-pathological (74%) gastroesophageal acid reflux did not differ significantly. Hp infected patients, in comparison to Hp-negative, had similar esophageal mucosa endoscopic appearance and greater intensity of histologic changes in esophageal mucosa. Studied patients group did not differ in respect of esophageal pH-metry parameters values, besides of greater number of esophageal alkalization (pH > 7) episodes in Hp-negative subjects. CONCLUSIONS: 1) Hp infection was diagnosed in 72% of patients with atypical chest pain. 28% had pathological gastroesophageal acid reflux. 2) Gastroesophageal acid reflux was not related to Hp infection. 3) Greater intensity of histologic changes in esophageal mucosa of Hp-positive patients with accompanying lack of differences in endoscopic estimation and similar endanger on gastric acid in pH-metry suggests protective role of esophageal alkalization against esophageal mucosa injury or higher intensity of regenerative inflammatory processes in Hp-positive patients.