Aisenberg J, Castell D O
Division of Gastroenterology, Mount Sinai School of Medicine (CUNY), New York City.
Mt Sinai J Med. 1994 Nov;61(6):476-83.
What are some take-home lessons on the syndrome of unexplained chest pain? Carefully exclude heart disease, which--unlike esophageally caused chest pain--may be life-threatening. Noncardiac chest pain is a common problem: at least 25% of chest pain patients in coronary care units or emergency rooms "rule out" for heart disease. It is a problem that has been vexing physicians for at least 100 years. The pain patterns in ischemic heart disease and in the unexplained pain syndromes, particularly reflux, may be identical. The mechanism may be an "irritable" esophagus, in which the visceral pain threshold is lowered. Look carefully for gastroesophageal reflux, and treat it aggressively. Finally, in all cases, try to establish a diagnosis if at all possible. When patients are told they don't have heart disease and no further workup is pursued, more than half of them continue to have significant morbidity from their chest pain, utilizing health care facilities and visiting doctors (34,35). Research over the past two decades has enlightened us about many patients with unexplained chest pain, but unfortunately we are still confused about many others, and for this group of patients a conservative therapeutic approach may be best.
关于不明原因胸痛综合征有哪些值得铭记的要点呢？要仔细排除心脏病，因为与食管源性胸痛不同，心脏病可能会危及生命。非心源性胸痛是个常见问题：在冠心病监护病房或急诊室中，至少25%的胸痛患者被排除患有心脏病。这是一个困扰医生至少100年的问题。缺血性心脏病和不明原因疼痛综合征（尤其是胃食管反流）的疼痛模式可能相同。其机制可能是食管“易激惹”，即内脏痛阈降低。要仔细排查胃食管反流，并积极进行治疗。最后，在所有病例中，尽可能尝试做出诊断。当患者被告知没有心脏病且不再进行进一步检查时，超过一半的患者仍会因胸痛而出现严重的发病情况，需要利用医疗设施并就医（参考文献34、35）。过去二十年的研究让我们对许多不明原因胸痛的患者有了更多了解，但不幸的是，我们对其他许多患者仍然感到困惑，对于这组患者，保守的治疗方法可能是最好的。
