Liuzzo John P, Ambrose John A
Division of Cardiology, Saint Vincent Catholic Medical Centers, New York, New York 10011, USA.
Cardiol Rev. 2005 Jul-Aug;13(4):167-73. doi: 10.1097/01.crd.0000148844.13702.ce.
Management of patients with coronary artery disease is a major challenge for physicians, patients, and the healthcare system. Chest pain experienced by patients with coronary disease can be of noncardiac origin, and symptoms frequently related to gastroesophageal etiologies. The distal esophagus and the heart share a common afferent nerve supply, suggesting that location and radiation of perceived pain may be identical. In addition, there is substantial overlap between the prevalence of coronary disease and gastroesophageal reflux disease. Many physicians, including cardiologists, prescribe acid-reducing therapy to coronary patients. However, no prospective, randomized studies to date have evaluated the potential benefit of such treatments to prevent chest pain symptoms for these patients. We review the studies on noncardiac chest pain demonstrating reflux in patients with and without coronary disease. Also, the association of reflux with exertional chest pain and cardiac syndrome X is discussed. A rationale is presented for prevention of noncardiac chest pain in coronary patients, and the potential role of acid-suppressive therapy in managing these patients is discussed.
冠状动脉疾病患者的管理对医生、患者及医疗保健系统而言都是一项重大挑战。冠心病患者所经历的胸痛可能源于非心脏因素，且症状常与胃食管病因相关。食管远端和心脏拥有共同的传入神经供应，这表明所感知疼痛的位置和放射部位可能相同。此外，冠心病患病率与胃食管反流病患病率之间存在大量重叠。包括心脏病专家在内的许多医生都给冠心病患者开了抑酸治疗药物。然而，迄今为止尚无前瞻性、随机研究评估此类治疗对预防这些患者胸痛症状的潜在益处。我们回顾了有关非心脏性胸痛的研究，这些研究表明有或无冠心病的患者都存在反流情况。此外，还讨论了反流与劳力性胸痛及心脏X综合征的关联。本文阐述了预防冠心病患者非心脏性胸痛的理论依据，并讨论了抑酸治疗在管理这些患者中的潜在作用。
