Possible pathogenetic role of Helicobacter pylori infection in cardiac syndrome X.

The diagnosis of cardiac syndrome X (CSX) is often a diagnosis of exclusion and hence requires a systematic and comprehensive assessment of each patient to rule out more common causes of chest discomfort. The definitive technique for the diagnosis of CSX is not currently available. Many patients with chest pain and normal coronary angiograms have neither metabolic nor hemodynamic evidence of myocardial ischemia. Causes of nonischemic chest pain such as esophageal dysfunction, pulmonary hypertension, and mitral valve prolapse, should also be considered and pursued. Although chronic inflammation induced by Helicobacter pylori infection might play a part in the pathophysiology of CSX, one can conclude that nonischemic chest pain resulting from gastrointestinal disease such as esophagitis, gastritis cannot be completely excluded in the patients with CSX. We believe future large scale prospective cohort studies will be needed to solve that dilemma.