Noncardiac chest pain

被引:27
作者
Botoman, VA [1 ]
机构
[1] Cleveland Clin, Dept Gastroenterol, Weston, FL 33331 USA
关键词
noncardiac chest pain; gastroesophageal reflux disease; proton pump inhibitors;
D O I
10.1097/00004836-200201000-00004
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Goals: Review of research directions in the etiology, evaluation, and treatment of patients with noncardiac chest pain. The author proposes a combined practical approach to noncardiac chest pain that incorporates these findings, which is useful in a clinical practice setting. Background: Several major schools of thought have emerged in the etiology of noncardiac chest pain: acid reflux, motor disorder, altered pain threshold/hypersensitivity, and association with psychiatric dysfunction. There is significant overlap among these. Occult gastroesophageal reflux disease (GERD) is more common than motor disorders and is found in 30% to 40% of these patients; a subset has hypersensitivity, with a normal pH profile. Esophageal motility testing and endoscopy have a more limited role than 24-hour pH testing. Impedance planimetry and balloon sensory provocative testing remain research tools. Provocative testing with hydrochloric acid or edrophonium is less helpful than pH monitoring. Gastroesophageal reflux disease-induced chest pain requires high-dose long-term proton pump inhibitors (PPIs): at least 4 to 8 weeks. Psychotropics are superior to placebo, both in patients with and without psychiatric dysfunction. Results: The author found combined PPIs and psychotropics helpful in patients with esophageal hypersensitivity and GERD, although supporting data is scant. Conclusions: A brief 1-week high-dose PPI challenge, i.e., omeprazole test, may be cost-effective in a primary care setting. However, this approach may not be useful in a referral setting, where pH data and diary assessment of associated symptoms provide useful management help. A behavioral model approach, with early emphasis on patient education, integrated with physiologic data helps the most.
引用
收藏
页码:6 / 14
页数:9
相关论文
共 68 条
[1]   Recent developments in chest pain of undetermined origin. [J].
Achem S.R. ;
DeVault K.R. .
Current Gastroenterology Reports, 2000, 2 (3) :201-209
[2]   Effects of omeprazole versus placebo in treatment of noncardiac chest pain and gastroesophageal reflux [J].
Achem, SR ;
Kolts, BE ;
MacMath, T ;
Richter, J ;
Mohr, D ;
Burton, L ;
Castell, DO .
DIGESTIVE DISEASES AND SCIENCES, 1997, 42 (10) :2138-2145
[3]  
ARNES JA, 1995, CAMBRIDGE COMPANION
[4]   Brain-gut axis in health and disease [J].
Aziz, Q ;
Thompson, DG .
GASTROENTEROLOGY, 1998, 114 (03) :559-578
[5]   Sustained esophageal contraction: A marker of esophageal chest pain identified by intraluminal ultrasonography [J].
Balaban, DH ;
Yamamoto, Y ;
Liu, JM ;
Pehlivanov, N ;
Wisniewski, R ;
DeSilvey, D ;
Mittal, RK .
GASTROENTEROLOGY, 1999, 116 (01) :29-37
[6]   GRADED ESOPHAGEAL BALLOON DISTENSION - A NEW PROVOCATIVE TEST FOR NONCARDIAC CHEST PAIN [J].
BARISH, CF ;
CASTELL, DO ;
RICHTER, JE .
DIGESTIVE DISEASES AND SCIENCES, 1986, 31 (12) :1292-1298
[7]  
BENJAMIN SB, 1979, GASTROENTEROLOGY, V77, P478
[8]  
BERNSTEIN LM, 1958, GASTROENTEROLOGY, V34, P760
[9]   Esophageal dysfunction in syndrome X [J].
Börjesson, M ;
Albertsson, P ;
Dellborg, M ;
Eliasson, T ;
Pilhall, M ;
Rolny, P ;
Mannheimer, C .
AMERICAN JOURNAL OF CARDIOLOGY, 1998, 82 (10) :1187-1191
[10]  
BOTOMAN VA, 1998, AM J GASTROENTEROL, V93, P611