Stahl W G, Beton R R, Johnson C S, Brown C L, Waring J P
Emory University School of Medicine, Department of Internal Medicine, Atlanta, GA 30322.
South Med J. 1994 Jul;87(7):739-42. doi: 10.1097/00007611-199407000-00013.
Patients with noncardiac chest pain frequently have some evidence of gastroesophageal reflux. Yet there are few formal studies on the treatment of what appears to be reflux-related chest pain. The purpose of this study was to evaluate the effectiveness of intensive antireflux therapy in patients with noncardiac chest pain and gastroesophageal reflux and to determine whether patients who will respond to this therapy can be identified through routine esophageal testing. Thirteen patients with noncardiac chest pain and evidence of gastroesophageal reflux were treated with intensive antireflux therapy featuring high-dose ranitidine. Chest pain symptoms were scored from 0 (none) to 4 (severe) at entry into the study and at 8 weeks. Mean symptom scores were 2.9 +/- 0.3 at entry and 0.7 +/- 0.3 at 8 weeks. All patients had improvement, including those with a normal endoscopic or barium study (nine patients) and those for whom earlier standard antireflux therapy had failed (seven patients). Only one patient had a positive acid perfusion test, and only seven had any correlation of chest pain and reflux episodes during ambulatory monitoring. We concluded that many patients with noncardiac chest pain have gastroesophageal reflux, including those for whom an empiric trial of standard antireflux therapy fails. More aggressive antireflux therapy often leads to improvement in symptoms. Diagnostic studies requiring strict correlation of chest pain symptoms and reflux episodes are insensitive methods of determining which patients will respond to antireflux therapy.
非心源性胸痛患者常常有一些胃食管反流的证据。然而，对于看似与反流相关的胸痛的治疗，正规研究却很少。本研究的目的是评估强化抗反流治疗对非心源性胸痛合并胃食管反流患者的有效性，并确定是否可以通过常规食管检查来识别对该治疗有反应的患者。13例非心源性胸痛且有胃食管反流证据的患者接受了以高剂量雷尼替丁为特色的强化抗反流治疗。在研究开始时和8周时，对胸痛症状进行评分，从0（无）到4（严重）。平均症状评分在研究开始时为2.9±0.3，8周时为0.7±0.3。所有患者均有改善，包括内镜或钡餐检查正常的患者（9例）以及早期标准抗反流治疗失败的患者（7例）。只有1例患者酸灌注试验呈阳性，动态监测期间只有7例患者的胸痛与反流发作有任何相关性。我们得出结论，许多非心源性胸痛患者存在胃食管反流，包括那些标准抗反流治疗经验性试验失败的患者。更积极的抗反流治疗通常会使症状改善。要求胸痛症状与反流发作严格相关的诊断研究，是确定哪些患者对抗反流治疗有反应的不敏感方法。
