Cardioesophageal Reflex. Should It Trigger Clinician's Response?

Cardiologists and gastroenterologists often encounter the coexistence of symptoms and functional abnormalities, but determining causation is more difficult. In 1962 Smith and Papp first coined the term "linked angina." Their statement was preceded by the experiment whereby increase in bile duct pressure elicited the typical chest pain in patients with ischemic heart disease. It was demonstrated that dysphagia can be associated with ventricular arrhythmia, suggestive of possible cardioesophageal reflex involvement. A potential association between gastroesophageal reflux disease and atrial fibrillation development has been proposed due to the close anatomic vicinity of the esophagus and the left atrium. It has been demonstrated that the patients suffering from prolonged gastro-esophageal acid reflux episodes and coronary spasm may be at higher risk for the development of linked angina and acute myocardial infarction. We believe cardioesophageal reflex is a probable mediator of linked angina. We recommend early treatment of gastroesophageal disorders in patients with symptomatic coronary arterial disease to alleviate the associated ischemic and arrhythmic burden.