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Release: March 10, 1999

UI researchers look at role of acid reflux in non-cardiac chest pain, other ailments

IOWA CITY, Iowa -- For doctors, symptoms such as heartburn and regurgitation usually make the diagnosis of gastroesophageal reflux (GERD) -- also known as acid reflux -- fairly straightforward. However, doctors and researchers believe there may be a stronger connection between GERD and other ailments such as non-cardiac chest pain, laryngitis or hoarseness and non-allergic asthma.

In a review article published in the January 1999 issue of Postgraduate Medicine, Satish Rao, M.D., associate professor in the UI department of internal medicine, and Victor Mujica, M.D., a fellow in the department's Division of Gastroenterology-Hepatology, detail the potential relationship between GERD and these three ailments.

"By better understanding some of the atypical complaints, doctors may more effectively treat these conditions," Rao said.

Previous studies have shown that patients with non-allergic asthma have increased amounts of acid in their esophagus, which is believed to be the cause of their asthmatic symptoms. But it is not clear how the excess acid in the esophagus blocks the passage of air, which causes an asthmatic reaction. One theory is that breathing in tiny gastric contents into the bronchial tree may lead to pulmonary damage and cause asthma. However, this theory remains unproven, Rao noted.

As for cardiac pain, many patients who believe they are having a heart attack may actually be suffering from symptoms of GERD. According to Rao "approximately 200,000 new cases are diagnosed each year for chest pain in which the cause is not heart-related." Chest pain induced by acid reflux may occur in patients with coronary artery disease or may be brought on by medications that are used in the treatment of heart disease, Rao said.

Similarly, Rao said that "in the general U.S. population there is a high occurrence of hoarseness, sore throat, and chronic cough," which also suggests that there may be a relationship between such problems and GERD.

While symptoms of GERD occur in only 20 to 40 percent of patients with throat problems, the absence of GERD symptoms does not necessarily mean there is no association between the two. A number of throat disorders have been associated with acid reflux, including sinusitis and vocal nodules, Rao said.

In many cases, treating GERD can improve non-allergic asthma, chest pain or throat problems. Lifestyle modifications (avoiding certain spicy foods as well as smoking and drinking, plus reducing dietary fat and meal size), antacids or anti-reflux surgery can be effective. However, since GERD is a chronic problem, medical treatment may continue throughout a patient's lifetime.

"It is important to see a gastroenterologist, particularly if an individual is over age 45 and has persistent symptoms or other health risks such as smoking, obesity, sedentary lifestyle and excessive ingestion of antacids," Rao said.