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 MJ, Gershlick AH, de Caestecker JS.
Affiliation(s): Digestive Diseases Centre, University Hospitals of Leicester, Leicester, UK.
Publication date & source: 2010, Aliment Pharmacol Ther. , 32(2):191-9
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.
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