Problems and opportunities of diagnosing reflux-induced cardialgia in the elderly at the health care primary level

Chukhrienko, N.D. (2025) Problems and opportunities of diagnosing reflux-induced cardialgia in the elderly at the health care primary level. Cімейна медицина. Європейські практики., 114 (4). pp. 52-59. ISSN 2786-7218

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Abstract

There are data suggesting that 20–40% of the global population exhibits symptoms representative of gastroesophageal reflux disease (GERD). GERD is more commonly diagnosed in mature, elderly, and senile individuals, accounting for approximately 23% among this group. The presence of comorbidities, the rate of which is increased with age, in combinationwith atypical extraesophageal GERD manifestations, particularly, cardialgia, form additional challenges for timelydiagnosis of coronary heart disease (CHD) and management of patients, especially at the primary care level.The objective: to study the causes and manifestations of cardialgia in elderly patients which are associated with GERDand to provide general practitioners with recommendations regarding medical management for this category of patients.Materials and methods. A study was conducted on 69 patients, in whom the indicators of gastric acid-forming function,indicators of basal gastric secretion, the presence of comorbid pathology and reflux score were studied. The features ofelectrocardiogram (ECG) changes depending on the number of refluxes were determined.Results. In 20 patients (37%), no significant number (above normal) of gastroesophageal reflux (GER) episodes weredetected. However, episodes of ST-segment depression on ECG were more than 2 mm in depth and lasted from 5 to 83 minutes.This allowed us to associate the pain in these patients with the presence of CHD. In 19 patients (33%), a significantnumber of GER episodes (> 50) was recorded, while no changes were observed on Holter ECG monitoring, which allowedus to associate this pain with extraesophageal non-cardiac manifestations of GERD. In 6 (11%) patients, both a significantnumber of reflux episodes (> 50) and ischemic changes on ECG were found. During the study, episodes of ST-segment depressionoccurred 2 to 9 times per day in these patients. In 2 of these patients, the clinical picture was similar, but the refluxepisodes and ECG changes were not temporally correlated. In 3 other patients, an increased rate of GER was observed10–15 minutes prior to ECG changes, in one of these cases, supraventricular extrasystoles occurred during the GER spike.In 10 (19%) patients, despite having complaints, no abnormalities were detected during simultaneous monitoring.Thus, the method of simultaneous 24-hour pH and ECG monitoring used in this study expands the possibilities for understandingthe causes, conditions, and nature of cardialgia. In some patients, it allows for differential diagnosis betweenGERD and CHD, as well as the recognition of their combined presence. There is a reason to believe that in some cases,GER in GERD acts as a trigger mechanism for manifestations in the form of pain similar to cardialgia, which can be assessedas angina attacks. Given the diagnostic difficulties of differential diagnosis of cardialgia in the elderly, an algorithmof actions for a doctor at the primary level of medical care has been developed.Conclusions. GERD, defined as a chronic, recurrent condition which is characterized by spontaneous or regularly repeatedreflux of gastric and duodenal contents into the esophagus, combined with cardialgia, poses specific challengesfor primary care physicians in terms of differential diagnosis. In some elderly patients, the coexistence of GERD andCHD is highly probable, even in the absence of pronounced pain, and this must be taken into account when prescribingantianginal medications that contribute to the relaxation of the lower esophageal sphincter.Timely diagnosis and treatment, as well as adherence to lifestyle recommendations, improve the prognosis of GERD andreduce its impact on the development of cardialgia.In addition to treating GERD with proton pump inhibitors and H2-receptor antagonists, depending on the severity (classifiedas A, B, C or D), patients should be advised to follow simple lifestyle measures, such as: elevating the head of the bed (in casesof nighttime symptoms); reducing body mass index (obesity plays a key role in the development of refractory GERD). In thepresence of GERD there is a risk of developing Barrett’s esophagus, adenocarcinoma, strictures and dysphagia, which shouldbe taken into account by the general practitioner – family medicine during long-term monitoring of the patient.

Item Type:	Article
Additional Information:	DOІ: 10.30841/2786-720X.4.2025.34949
Uncontrolled Keywords:	reflux-induced cardialgia, comorbidity, differential diagnosis, chest pain, advanced age, primary care level
Subjects:	Family Medicine
Divisions:	Faculty of Postgraduate Education > Department of Family Medicine FPE
Depositing User:	Аліна Чеботарьова
Date Deposited:	27 Jan 2026 10:20
Last Modified:	27 Jan 2026 10:20
URI:	http://repo.dma.dp.ua/id/eprint/9690

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