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Background: Gastro-esophageal reflux disease(GERD) may cause chest pain. The aim was to determine the correlation between ischemia and gastro-esophageal reflux in patients with CAD and to assess the influence of short-term “ anti-reflux” therapy on the ischemia in patients with GERD and CAD. Methods: Fifty patients with angiographically proven CAD underwent simultaneous 24-h continuous ECG and esophageal pH monitoring. We assessed the number of ST-segment depression episodes(ST dep.) and total duration of ischemic episodes, expressed as total ischemic burden(TIB). In pH-metry, we assessed: time percentage of pH lower than 4, total time of pH lower than 4 and the number of pathological refluxes(PR). Patients fulfilling the GERD criteria received a 7-day therapy with omeprazol 20 mg bid. On the 7th day of therapy, simultaneous Holter and esophageal pH monitoring was repeated. Results: Total number of 224 PRs in 42 patients(84% ) was recorded during esophageal pH- metry. GERD criteria were fulfilled in 23 patients(46% ). Out of 218 episodes of ST dep., 45(20.6% ) correlated with PR. GERD patients had larger TIB and higher number of ST dep.(p< 0.015 and p< 0.035, respectively). The anti-reflux therapy reduced all analyzed parameters of esophageal pH monitoring(p< 0.0022) as well as the number of ST dep.(p< 0.012) and TIB(p< 0.05). Conclusions: Gastro-esophageal reflux disease is common in patients with CAD and may provoke myocardial ischemia. Short-term proton pump inhibitors therapy that restores normal esophageal pH significantly reduces myocardial ischemia, possibly due to elimination of acid-derived esophago-cardiac reflex compromising coronary perfusio - the phenomenon known as “ linked angina” .