Karlaftis Anastasios, Karamanolis George, Triantafyllou Konstantinos, Polymeros Demetrios, Gaglia Asimina, Triantafyllou Maria, Papanikolaou Ioannis S, Ladas Spiros D
Hepatogastroenterology Department, 1 Propaedeutic Internal Medicine, Athens Medical School, Laikon General Hospital (Anastasios Karlaftis, Georgios Karamanolis, Spyros D. Ladas), Athens, Greece ; Hepatogastroenterology Department, 2 Propaedeutic Internal Medicine, Athens Medical School, Attikon University General Hospital (Anastasios Karlaftis, Georgios Karamanolis, Konstantinos Triantafylloy, Demetrios Polymeros, Asimina Gaglia, Maria Triantafyllou, Ioannis S. Papanikolaou), Athens, Greece.
Hepatogastroenterology Department, 2 Propaedeutic Internal Medicine, Athens Medical School, Attikon University General Hospital (Anastasios Karlaftis, Georgios Karamanolis, Konstantinos Triantafylloy, Demetrios Polymeros, Asimina Gaglia, Maria Triantafyllou, Ioannis S. Papanikolaou), Athens, Greece.
Ann Gastroenterol. 2013;26(4):314-318.
In patients with non-cardiac chest pain (NCCP), gastroesophageal reflux disease (GERD) is thought to be the commonest cause. Ambulatory pH monitoring and/or endoscopy are usually performed in order to confirm GERD diagnosis. At present, clinical diagnosis of reflux in patients with NCCP is uncertain.The aim of the study was to determine clinical characteristics that could identify GERD in patients with NCCP.
A total of 52 (age 52.8±1.8 yrs, 29 women) patients with NCCP underwent combined impedance-pH monitoring and gastroscopy. GERD diagnosis was based on the presence of esophagitis and/or a positive impedance-pH study (symptom index >50% and/or esophageal acid exposure time >4.0%). Patients were then divided into 2 groups: GERD- and non-GERD-related NCCP. Demographic and clinical parameters were compared between these two groups.
GERD-related NCCP was found in 30 (58%) patients. Demographic characteristics were similar in both groups. Chest pain showed no difference in severity, radiation, relation to exercise and relation to sleep between the two groups. In the GERD-related NCCP group, chest pain was more prevalent during the postprandial period (P<0.05) and was relieved by spontaneous use of antireflux drugs (P<0.05). The presence of typical reflux symptoms favored a GERD diagnosis (P<0.05).
A proportion of patients with NCCP showed clinical characteristics suggesting a GERD diagnosis. Typical reflux symptoms, postprandial chest pain and use of anti-reflux drugs for pain relief were the best predictors for GERD-related NCCP.
在非心源性胸痛（NCCP）患者中，胃食管反流病（GERD）被认为是最常见的病因。通常进行动态pH监测和/或内镜检查以确诊GERD。目前，NCCP患者反流的临床诊断尚不确定。本研究的目的是确定可识别NCCP患者中GERD的临床特征。
共有52例（年龄52.8±1.8岁，女性29例）NCCP患者接受了联合阻抗-pH监测和胃镜检查。GERD的诊断基于食管炎的存在和/或阻抗-pH研究阳性（症状指数>50%和/或食管酸暴露时间>4.0%）。然后将患者分为两组：GERD相关和非GERD相关的NCCP。比较两组的人口统计学和临床参数。
30例（58%）患者被发现患有GERD相关的NCCP。两组的人口统计学特征相似。两组之间胸痛在严重程度、放射部位、与运动的关系和与睡眠的关系方面没有差异。在GERD相关的NCCP组中，胸痛在餐后更常见（P<0.05），并且通过自发使用抗反流药物可缓解（P<0.05）。典型反流症状的存在有利于GERD的诊断（P<0.05）。
一部分NCCP患者表现出提示GERD诊断的临床特征。典型反流症状、餐后胸痛和使用抗反流药物缓解疼痛是GERD相关NCCP的最佳预测指标。
