← Blog

Stable Angina vs. Gastroesophageal Reflux: Key Points for Diagnosing Chest Pain with Stress Tests and Endoscopy

A middle-aged Hispanic man in a medical office, looking thoughtful and slightly concerned, listens to a Hispanic female doctor explaining something with a reassuring smile. On the desk, a stethoscope and a heart model emphasize a discussion about diagnosing chest pain, potentially related to stable angina or gastroesophageal reflux, and the need for a stress test or endoscopy.

Chest pain is a common symptom that can indicate various medical conditions, ranging from cardiac issues to gastrointestinal disorders. Two of the most frequent causes of chest pain are stable angina and gastroesophageal reflux (GERD). Distinguishing between these two conditions is crucial for accurate diagnosis and treatment.

Diving into Differential Diagnosis

Stable angina is characterized by predictable chest pain that occurs with physical exertion or emotional stress and is relieved by rest or nitroglycerin. This type of angina is a sign of ischemic heart disease and can be a precursor to more severe conditions such as myocardial infarction. In contrast, gastroesophageal reflux presents with chest pain often described as a burning sensation behind the sternum, and it may be accompanied by acid regurgitation.

A recent study has shown that prolactin levels may be elevated in patients with stable angina and GERD, suggesting a possible relationship between these conditions. In patients with both conditions, there was an increase in the total duration of myocardial ischemia episodes, highlighting the importance of considering comorbidities when evaluating chest pain [1].

The use of stress tests and endoscopy can be helpful in differentiating between these conditions. One study demonstrated that suppression of gastric acid production with proton pump inhibitors like rabeprazole improved stress test outcomes in patients with coronary artery disease, suggesting that some angina symptoms may be related to GERD [2]. Additionally, in patients with typical chest pain and normal coronary angiography, a high incidence of gastroesophageal disease was found, underscoring the need for gastroesophageal studies for proper management of chest pain [3].

Conclusions

The differential diagnosis between stable angina and gastroesophageal reflux is essential for the effective management of chest pain. Careful evaluation of symptoms, along with diagnostic tests such as stress tests and endoscopy, can help identify the underlying cause of the pain. Furthermore, considering the possibility of comorbidities and the impact of psychological factors is crucial for accurate diagnosis and effective treatment.

Referencias


Created 6/1/2025