Kachintorn Udom
Faculty of Medicine Siriraj Hospital, Bangkok, Thailand.
J Gastroenterol Hepatol. 2005 Dec;20 Suppl:S2-5. doi: 10.1111/j.1440-1746.2005.04164.x.
Noncardiac chest pain (NCCP) is a heterogeneous disorder associated with substantial health-care costs and resource utilization. NCCP is defined by recurrent episodes of substernal chest pain in patients lacking a cardiac cause after a comprehensive evaluation. The magnitude of the problem is quite high because of fear of serious or life-threatening heart diseases. Patients with chest pain who present for the first time to ambulatory care or to the emergency room, only 11% to 39% are ultimately diagnosed with coronary artery disease. The likely causes of NCCP are numerous and often overlap. Diagnosing NCCP is difficult because NCCP remains a diagnosis of exclusion that encompasses heterogeneous patient populations. First, cardiac ischemic must be excluded and coronary angiography remains the gold standard. Once cardiac causes have been ruled out, a diagnosis of NCCP is made. Mostly, the source for NCCP originates in essence from the esophagus. Gastroesophageal reflux disease (GERD) is the most common esophageal diseases present in patients with NCCP. An initial empiric trail of high-dose acid suppression is the most cost-effective measure in the management of these patients. When a diagnostic workup is chosen, it centers on upper gastrointestinal endoscopy, 24-hr esophageal pH monitoring and esophageal manometry.
非心源性胸痛（NCCP）是一种异质性疾病，与高昂的医疗费用和资源利用相关。NCCP的定义是在经过全面评估后，无心脏病因的患者反复出现胸骨后胸痛。由于担心严重或危及生命的心脏病，该问题的严重程度相当高。首次到门诊或急诊室就诊的胸痛患者中，最终只有11%至39%被诊断为冠状动脉疾病。NCCP的可能病因众多且常常相互重叠。诊断NCCP很困难，因为NCCP仍然是一种排除性诊断，涵盖了异质性的患者群体。首先，必须排除心脏缺血，冠状动脉造影仍然是金标准。一旦排除了心脏病因，即可做出NCCP的诊断。大多数情况下，NCCP的病因本质上源于食管。胃食管反流病（GERD）是NCCP患者中最常见的食管疾病。在这些患者的管理中，初始大剂量抑酸试验是最具成本效益的措施。当选择进行诊断性检查时，其重点是上消化道内镜检查、24小时食管pH监测和食管测压。
