未确诊胸痛的管理方法：胃食管反流病会是病因吗？
Approach to managing undiagnosed chest pain: could gastroesophageal reflux disease be the cause?
作者信息
Flook Nigel, Unge Peter, Agréus Lars, Karlson Björn W, Nilsson Staffan
机构信息
Department of Family Medicine, University ofAlberta, Edmonton,.
出版信息
Can Fam Physician. 2007 Feb;53(2):261-6.
OBJECTIVE
To highlight gastroesophageal reflux disease as a common cause of undiagnosed chest pain.
SOURCES OF INFORMATION
Diagnostic considerations are based on information in peer-reviewed articles retrieved from MEDLINE. Studies had to be in English and involve at least 30 subjects. Population-based studies had to have a sample size of at least 300 and a response rate of at least 60%. Thirty-seven relevant articles were found.
MAIN MESSAGE
Clinical management of patients presenting with diagnostically challenging chest pain starts with a careful search for coronary artery disease and other potentially life-threatening causes. Investigations must continue until the underlying disease is identified and symptoms have been effectively controlled. Ongoing symptoms of undiagnosed chest pain cause considerable suffering, impair quality of life, and add unnecessary costs to the health care system. In more than half the patients with undiagnosed chest pain, symptoms are caused by gastroesophageal disease. Empirical acid-suppressive therapy with a proton pump inhibitor can assist clinicians in identifying patients whose symptoms are acid-related.
CONCLUSION
Many patients with undiagnosed chest pain can be managed in primary care, minimizing the need for referrals and costly investigations.
目的
强调胃食管反流病是未确诊胸痛的常见原因。
信息来源
诊断考量基于从MEDLINE检索到的同行评审文章中的信息。研究必须为英文且涉及至少30名受试者。基于人群的研究样本量必须至少为300，应答率至少为60%。共找到37篇相关文章。
主要信息
对于表现出诊断困难的胸痛患者，临床管理首先要仔细排查冠状动脉疾病和其他潜在的危及生命的病因。调查必须持续进行，直到确定潜在疾病并有效控制症状。未确诊胸痛的持续症状会造成相当大的痛苦，损害生活质量，并给医疗保健系统增加不必要的成本。在超过半数未确诊胸痛的患者中，症状由胃食管疾病引起。使用质子泵抑制剂进行经验性抑酸治疗可帮助临床医生识别症状与酸相关的患者。
结论
许多未确诊胸痛的患者可在初级保健中得到管理，从而尽量减少转诊和昂贵检查的需求。
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