Bortolotti M, Marzocchi A, Bacchelli S, Esposti A D, Sarti P, Brunelli F, Labriola E, Barbara L
1st Medical Clinic, University of Bologna, Italy.
Hepatogastroenterology. 1990 Jun;37(3):316-8.
In a series of 18 patients with angina pectoris, in whom treatment over at least 3 years with nitroderivatives and Ca-antagonists had become partially ineffective on chest pain, and in 18 patients with angina-like non-cardiac chest pain, the following examinations were carried out: upper gut x-ray and endoscopy, acid perfusion test, esophageal manometry, 24-hour esophageal pH monitoring associated with Holter recording. The presence or absence of coronary insufficiency was established by means of scintigraphic and ECG tests, Holter monitoring and coronary arteriography. In both groups the majority of patients had abnormal esophageal function, but in patients with angina pectoris treated for a long period of time the motility changes were prevalently reflux-related. With respect to the origin of chest pain, the esophagus was found to be the likely cause in 4 patients with angina pectoris, and the probable cause in another 10 of the same group; it was the likely cause in 7 patients without angina pectoris, and the probable cause in another 7 of the same group. As nitroderivatives and Ca-antagonists decrease the LES tone and the amplitude of esophageal pressure waves, long-term treatment with these drugs may be taken into account in the genesis of gastro-esophageal reflux and related changes, including esophageal pain.
在一组18例心绞痛患者中，他们使用硝基衍生物和钙拮抗剂治疗至少3年，胸痛症状已部分无效；另一组18例有类似心绞痛症状的非心脏性胸痛患者，进行了以下检查：上消化道X线检查和内镜检查、酸灌注试验、食管测压、24小时食管pH监测并同步进行动态心电图记录。通过闪烁扫描、心电图检查、动态心电图监测和冠状动脉造影来确定是否存在冠状动脉供血不足。两组中的大多数患者食管功能异常，但在长期接受治疗的心绞痛患者中，运动变化主要与反流有关。关于胸痛的起源，在4例心绞痛患者中发现食管可能是病因，同一组中的另外10例可能是病因；在7例无心绞痛的患者中食管可能是病因，同一组中的另外7例可能是病因。由于硝基衍生物和钙拮抗剂会降低食管下括约肌张力和食管压力波幅度，在胃食管反流及相关变化（包括食管疼痛）的发生过程中，可能需要考虑长期使用这些药物的因素。
