Frieling Thomas
Department of Gastroenterology, Hepatology, Infectiology, Neurogastroenterology, Hematology, Oncology, and Palliative Medicine, HELIOS-Clinic Krefeld, Krefeld, Germany.
Visc Med. 2018 Apr;34(2):92-96. doi: 10.1159/000486440. Epub 2018 Apr 12.
Non-cardiac chest pain (NCCP) is recurrent angina pectoris-like pain without evidence of coronary heart disease in conventional diagnostic evaluation. The prevalence of NCCP is up to 70% and may be detected (in this order) at all levels of the medical health care system (general practitioner, emergency department, chest pain unit, coronary care). Reduction of quality of life due to NCCP is comparable, and partially even higher, to that caused by cardiac chest pain. Reasons for psychological strain are symptom recurrence in approximately 50%, nonspecific diagnosis with resulting uncertainty, and insufficient integration of other medical disciplines in the diagnostic workup.
The management of patients with chest pain has to be multidisciplinary because non-cardiac causes may be frequently encountered. Especially gastroenterological expertise is required since the cause of chest pain is gastroesophageal reflux disease (GERD) in 50-60%, hypercontractile esophageal motility disorders with nutcracker/jackhammer esophagus or diffuse esophageal spasm or achalasia in 15-18%, and other esophageal alterations (e.g., infectious esophageal inflammation, drug-induced ulcers, rings, webs, eosinophilic esophagitis) in 32-35%.
This review highlights the importance of regular interdisciplinary ward rounds and management of chest pain units.
非心源性胸痛（NCCP）是指在传统诊断评估中出现类似心绞痛的反复性疼痛，但无冠心病证据。NCCP的患病率高达70%，在各级医疗保健系统（全科医生、急诊科、胸痛单元、冠心病监护病房）中均可能被检测到（按此顺序）。NCCP导致的生活质量下降与心源性胸痛相当，部分甚至更高。心理压力的原因包括约50%的症状复发、非特异性诊断导致的不确定性以及其他医学学科在诊断检查中整合不足。
胸痛患者的管理必须是多学科的，因为非心脏原因可能经常遇到。尤其需要胃肠病学专业知识，因为胸痛的原因在50% - 60%是胃食管反流病（GERD），15% - 18%是高收缩性食管动力障碍，如胡桃夹食管/强力收缩食管、弥漫性食管痉挛或贲门失弛缓症，32% - 35%是其他食管改变（如感染性食管炎、药物性溃疡、环、蹼、嗜酸性食管炎）。
本综述强调了定期进行跨学科查房和胸痛单元管理的重要性。
