Woolf P K, Gewitz M H, Berezin S, Medow M S, Stewart J M, Fish B G, Glassman M S, Newman L J
Department of Pediatrics, New York Medical College, Valhalla 10595.
J Adolesc Health. 1991 May;12(3):247-50. doi: 10.1016/0197-0070(91)90018-h.
Chest pain in adolescents and children is usually not of cardiac origin. Of cardiac conditions commonly linked to chest pain in childhood, mitral valve prolapse (MVP) is the most prevalent, but this association has recently been questioned. In light of recent reports of gastroesophageal sources of chest pain in adults with MVP, we performed a comprehensive gastroesophageal evaluation of 17 preadolescents and adolescents with mitral valve prolapse who had chest pain as their presenting symptom. Evaluation consisted of esophageal manometry, Bernstein test, esophageal pH probe, and/or esophagogastroscopy. Fourteen of the 17 patients had at least one abnormal finding. Five patients had esophagitis, five had gastritis, one had high-amplitude esophageal contractions, one had abnormal esophageal manometry with positive Bernstein test, one had esophageal reflux and positive Bernstein test, and one had abnormal manometry with esophageal reflux. The 13 patients with esophagitis, gastritis, reflux, or positive Bernstein test were treated with antacid, with resolution of chest pain in 12 patients. Two of these patients underwent follow-up endoscopy with documentation of improvement. The patient with high-amplitude esophageal contractions was treated with dicyclomine, which resulted in resolution of chest pain. The observation that the chest pain was not related to mitral valve prolapse is important in clinical practice and raises further questions as to whether mitral valve prolapse causes chest pain.
青少年和儿童的胸痛通常并非心脏原因所致。在通常与儿童胸痛相关的心脏疾病中，二尖瓣脱垂（MVP）最为常见，但这种关联最近受到了质疑。鉴于近期有报道称患有MVP的成年人胸痛源于胃食管问题，我们对17名以胸痛为主要症状的患有二尖瓣脱垂的青春期前儿童和青少年进行了全面的胃食管评估。评估包括食管测压、伯恩斯坦试验、食管pH探头检查和/或食管胃镜检查。17名患者中有14名至少有一项异常发现。5名患者患有食管炎，5名患有胃炎，1名有高振幅食管收缩，1名食管测压异常且伯恩斯坦试验呈阳性，1名有食管反流且伯恩斯坦试验呈阳性，1名测压异常伴有食管反流。13名患有食管炎、胃炎、反流或伯恩斯坦试验呈阳性的患者接受了抗酸治疗，12名患者的胸痛得到缓解。其中2名患者接受了随访内镜检查，结果显示病情有所改善。患有高振幅食管收缩的患者接受了双环维林治疗，胸痛得以缓解。胸痛与二尖瓣脱垂无关这一观察结果在临床实践中很重要，并引发了关于二尖瓣脱垂是否会导致胸痛的进一步疑问。
