Mikhail Mena, Crowley George, Haider Syed Hissam, Veerappan Arul, Lam Rachel, Talusan Angela, Clementi Emily, Ostrofsky Dean, Kwon Sophia, Nolan Anna
Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University School of Medicine, New York City, New York, USA.
Department of Environmental Medicine, New York University School of Medicine, New York City, New York, USA.
EMJ Gastroenterol. 2018 Dec;7(1):103-112. Epub 2018 Dec 11.
The prevalence of non-cardiac chest pain (NCCP) ranges from 13-33%. A majority of those presenting with a chief complaint of chest pain are found to have a diagnosis of NCCP. Aerodigestive diseases are a cause of NCCP, and billions of dollars are spent annually on the treatment of NCCP. Furthermore, NCCP can cause significant psychological stress. NCCP is commonly diagnosed when patients have chest pain despite a normal cardiac evaluation. The leading cause of NCCP is gastro-oesophageal reflux disease (GORD). GORD should be suspected in patients who report a history of acid regurgitation, cough, dysphagia, and bloating. Another common cause of NCCP is obstructive airway disease (OAD). A thorough history and review of the symptoms should be performed for those with suspected NCCP, especially because of the contributing end organs. It is known that environmental exposures can commonly cause GORD and OAD; however, NCCP has not been fully explored in the context of environmental exposure. Patients with a history of exposure to particulate matter can develop environmental-exposure-associated GORD and coexisting OAD. This narrative review aims to provide a practical overview of NCCP, its causes, their relation to environmental exposure, and associated biomarkers. The authors used a PubMed search that spanned 2003-2018 to accomplish this. Additionally, this review provides a broad overview of biomarkers of GORD-associated NCCP and OAD-associated NCCP due to environmental exposure.
非心源性胸痛（NCCP）的患病率在13%至33%之间。大多数以胸痛为主诉就诊的患者被诊断为NCCP。气消化道疾病是NCCP的一个病因，每年在NCCP治疗上花费数十亿美元。此外，NCCP会导致严重的心理压力。当患者尽管心脏评估正常但仍有胸痛时，通常会诊断为NCCP。NCCP的主要原因是胃食管反流病（GORD）。对于有反酸、咳嗽、吞咽困难和腹胀病史的患者，应怀疑患有GORD。NCCP的另一个常见原因是阻塞性气道疾病（OAD）。对于疑似NCCP的患者，应进行全面的病史询问和症状回顾，尤其是考虑到相关的终末器官。已知环境暴露通常会导致GORD和OAD；然而，在环境暴露背景下，NCCP尚未得到充分研究。有接触颗粒物病史的患者可能会发展为与环境暴露相关的GORD和并存的OAD。这篇叙述性综述旨在对NCCP、其病因、与环境暴露的关系以及相关生物标志物提供一个实用的概述。作者通过检索2003年至2018年的PubMed来完成这项工作。此外，本综述还对因环境暴露导致的GORD相关NCCP和OAD相关NCCP的生物标志物进行了广泛概述。
