Update on Noncardiac Chest Pain

Shrestha, Sanjeeb; Pasricha, Pankaj J.

doi:10.1159/000051387

Cited by 21 publications

(12 citation statements)

References 38 publications

(61 reference statements)

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“…This was not associated with luminal constriction, nor with longitudinal muscle fibre contraction, and was not therefore recorded manometrically. 26 This may go some way towards explaining the poor utility of manometry.…”

Section: Oesophageal Spasmmentioning

confidence: 99%

The heart and the oesophagus: intimate relations

Heatley

Rose

Weston

2005

Postgraduate Medical Journal

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The close anatomical relations of the heart and oesophagus, and the similarity of symptoms attributable to disorders of either organ, often lead to diagnostic difficulty in patients with chest pain. A definitive diagnosis of non-cardiac chest pain attributable to oesophageal reflux or spasm is hampered, both by the need for prolonged ambulatory monitoring of pH, manometry, and endoscopy, and by the common occurrence of asymptomatic reflux and spasm, and the corresponding difficulty in linking an episode of reflux or spasm with an episode of pain. Moreover, some patients with non-cardiac chest pain and normal tests of oesophageal structure and function have centrally mediated hypersensitivity, both within and without the oesophagus. Rather than proceed with investigations, in the absence of symptoms to suggest structural disease of the oesophagus, it would be reasonable to attempt symptomatic treatment with a proton pump inhibitor or an antidepressant.

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Section: Oesophageal Spasmmentioning

confidence: 99%

The heart and the oesophagus: intimate relations

Heatley

Rose

Weston

2005

Postgraduate Medical Journal

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“…Shrestha et al [4] reported that 30% of noncardiac chest pain was caused by esophageal diseases such as GERD. Since the innervation and location of the esophageal nervous system in the body overlaps with the cardiac nervous system, symptoms are often similar.…”

Section: Discussionmentioning

confidence: 99%

“…linked angina) [3] . As a result, differential diagnosis is often difficult and many patients with esophageal chest pain are misdiagnosed as having coronary artery disease [4] . Hence, the percentage of patients that are correctly treated and cured is relatively low.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis of chest pain with foregut symptoms in Chinese patients

Deng

Wang²,

Jiang³

et al. 2009

WJG

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AIM:To evaluate the diagnosis of chest pain with foregut symptoms in Chinese patients. M E T H O D S :E s o p h a g e a l m a n o m e t r i c s t u d i e s , 24-h introesophageal pH monitoring and 24-h electrocardiograms (Holter electrocardiography) were performed in 61 patients with chest pain. RESULTS:Thirty-nine patients were diagnosed with non-specific esophageal motility disorders (29 patients with abnormal gastroesophageal reflux and eight patients with myocardial ischemia). Five patients had diffuse spasm of the esophagus plus abnormal gastroesophageal reflux (two patients had concomitant myocardial ischemia), and one patient was diagnosed with nutcracker esophagus. CONCLUSION:The esophageal manometric studies, 24-h intra-esophageal pH monitoring and Holter electrocardiography are significant for the differential diagnosis of chest pain, particularly in patients with foregut symptoms. In cases of esophageal motility disorders, pathological gastroesophageal reflux may be a major cause of chest pain with non-specific esophageal motility disorders. Spasm of the esophageal smooth muscle might affect the heart-coronary smooth muscle, leading to myocardial ischemia.

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“…pH-metry should be used initially, preferably after treatment failure [7]. Esophageal barostat may have a role in determining those patients with symptoms due to visceral hyperalgesia.…”

Section: Esophageal Manometrymentioning

confidence: 99%

Tests for the Evaluation of Functional Gastrointestinal Disorders

Knippig

Fass²,

Malfertheiner³

2001

Dig Dis

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Functional gastrointestinal disorders are a common problem. Different noninvasive and invasive strategies have been carried out in recent years to study the role of impaired myoelectrical activity, tone, compliance, transit and perception of the gastrointestinal tract. Esophageal barostat examination and impedance measurements have been added to standard clinical methods like manometry and pH-metry for the esophagus. Bilirubin measurement allows the evaluation of duodenogastroesophageal reflux and perception can be studied by gastric barostat. Electrogastrography and tenostat test are still research tools. Rectal or sigmoid barostat examination is a new research tool to study visceral sensitivity in the lower gastrointestinal tract. New methods – like functional MRI and SPECT – are promising features for the future.

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Update on Noncardiac Chest Pain

Cited by 21 publications

References 38 publications

The heart and the oesophagus: intimate relations

The heart and the oesophagus: intimate relations

Diagnosis of chest pain with foregut symptoms in Chinese patients

Tests for the Evaluation of Functional Gastrointestinal Disorders

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