Katz P O
Division of Gastroenterology, The Graduate Hospital, Philadelphia, PA 19146, USA.
Semin Gastrointest Dis. 2001 Jan;12(1):38-45.
Patients with unexplained or noncardiac chest pain continue to present a difficult challenge to the gastroenterologist. Cardiac disease must be ruled out first as the history will not distinguish between coronary artery disease and other causes of substernal chest pain. A systematic approach to evaluation should include reassurance that the heart is normal and attempts to confirm an esophageal etiology. Gastroesophageal reflux disease is the most common esophageal abnormality associated with unexplained chest pain and may be identified by an aggressive trial of anti-reflux therapy or an abnormal prolonged ambulatory pH monitoring study. Endoscopy is almost always normal and of less use in this population than in those with heartburn as the presenting symptom. Judicious use of manometry with provocative testing to evaluate for esophageal motility abnormalities or esophageal sensitivity allows for optimal evaluation of those who do not have gastroesophageal reflux disease. This article reviews the clinical presentation, differential diagnosis, and approach to evaluation and therapy of this complex group of patients.
不明原因或非心脏性胸痛患者持续给胃肠病学家带来难题。必须首先排除心脏疾病，因为病史无法区分冠状动脉疾病和其他导致胸骨后胸痛的病因。系统的评估方法应包括让患者放心心脏正常，并尝试确认食管病因。胃食管反流病是与不明原因胸痛相关的最常见食管异常情况，可通过积极的抗反流治疗试验或异常的长时间动态pH监测研究来确定。内镜检查几乎总是正常的，在这类患者中其用途不如以烧心为主要症状的患者群体。明智地使用测压法并进行激发试验以评估食管动力异常或食管敏感性，有助于对没有胃食管反流病的患者进行最佳评估。本文综述了这类复杂患者群体的临床表现、鉴别诊断以及评估和治疗方法。
