DeMeester T R, O'Sullivan G C, Bermudez G, Midell A I, Cimochowski G E, O'Drobinak J
Ann Surg. 1982 Oct;196(4):488-98. doi: 10.1097/00000658-198210000-00013.
Ten per cent of patients with angina pectoris have normal coronary arteries and cardiac function and, despite this reassurance, continue to have chest pain. Since pain of cardiac or esophageal origin is clinically difficult to differentiate, 50 patients with severe chest pain, normal cardiac function, and normal coronary arteriography with ergotamine provocation were evaluated with a symptomatic questionnaire and esophageal function test. On 24-hour esophageal pH monitoring, 23 patients had abnormal reflux, and 27 were normal. There was no difference in the incidence and severity of chest pain, esophageal symptoms, or medication taken between refluxers and nonrefluxers. Ten refluxers and ten nonrefluxers had chest pain on exercise electrocardiography. Thirteen refluxers documented chest pain during the pH monitoring period, and in 12 it coincided with a reflux episode. Fifteen nonrefluxers documented chest pain during the monitoring period, and in only one did it coincide with a reflux episode. Of the 23 refluxers, 12 were treated with medical therapy and 11 by a surgical antireflux procedure, and all followed for two to three years. Ten (91%) of the 11 surgically treated patients are totally free of chest pain compared with five (42%) of the 12 medically treated patients. All 12 patients who had chest pain coincide with a documented reflux episode responded positively to antireflux therapy, eight surgical and four medical. It is concluded that 46% of patients complaining of angina pectoris with normal cardiac function and coronary arteriography have gastroesophageal reflux as a possible etiology. Seventy-three per cent of these patients have total abolition of chest pain by either surgical or medical antireflux therapy. Patients whose experience of chest pain coincided with a documented reflux episode on 24-hour esophageal pH monitoring had a 100% response to medical or surgical therapy. Overall, surgical therapy gave better results (91%) but was associated with an 18% temporary morbidity. Objective evaluation of reflux status and its correlation to the symptom of chest pain by 24-hour pH monitoring allows for selective therapy in these difficult to manage patients.
10%的心绞痛患者冠状动脉和心脏功能正常，尽管得到了这样的保证，但仍持续胸痛。由于心脏或食管源性疼痛在临床上难以区分，因此对50例有严重胸痛、心脏功能正常且冠状动脉造影正常并经麦角胺激发试验的患者进行了症状问卷和食管功能测试评估。在24小时食管pH监测中，23例患者有异常反流，27例正常。反流者和非反流者在胸痛的发生率和严重程度、食管症状或用药方面没有差异。10例反流者和10例非反流者在运动心电图检查时有胸痛。13例反流者在pH监测期间记录到胸痛，其中12例与反流发作同时出现。15例非反流者在监测期间记录到胸痛，只有1例与反流发作同时出现。在23例反流者中，12例接受药物治疗，11例接受抗反流手术治疗，均随访2至3年。11例接受手术治疗的患者中有10例（91%）完全没有胸痛，而12例接受药物治疗的患者中有5例（42%）。所有胸痛与记录到的反流发作同时出现的12例患者对抗反流治疗均有积极反应，8例手术治疗，4例药物治疗。得出结论，46%抱怨有心绞痛但心脏功能和冠状动脉造影正常的患者可能病因是胃食管反流。这些患者中有73%通过手术或药物抗反流治疗完全消除了胸痛。在24小时食管pH监测中，胸痛经历与记录到的反流发作同时出现的患者对药物或手术治疗的反应为100%。总体而言，手术治疗效果更好（91%），但有18%的临时发病率。通过24小时pH监测对反流状态及其与胸痛症状的相关性进行客观评估，有助于对这些难以治疗的患者进行选择性治疗。
