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[Role of functional esophageal disturbances in the development of chest pain]
1Zakładu Pielegniarstwa Klinicznego i Rehabilitacji Wydziału Lekarskiego Sl. Ak. Med. w Katowicach.
Insights
Recurrent chest pain often stems from esophageal issues, not just heart problems. Advanced tests like pH monitoring and psychological evaluations are key to diagnosing unexplained chest pain.
Area of Science:
- Gastroenterology
- Cardiology
- Clinical Medicine
Context:
- Recurrent chest pain is a common clinical challenge, often initially investigated for cardiac causes.
- Coronary heart disease is frequently excluded, leaving a significant portion of patients with unexplained chest pain.
- Functional esophageal disorders are increasingly recognized as potential sources of such symptoms.
Purpose:
- To highlight the role of esophageal dysfunction in unexplained recurrent chest pain.
- To emphasize the limitations of traditional diagnostic methods for chest pain.
- To advocate for comprehensive esophageal function testing.
Summary:
- Esophageal causes, including gastroesophageal reflux and motor abnormalities (e.g., "nutcracker esophagus"), can mimic cardiac pain.
- Diagnostic confirmation requires specialized tests beyond standard endoscopy and X-rays, such as esophageal manometry, pH monitoring, and challenge tests.
- Abnormal visceral perception ("irritable esophagus") and psychological factors may contribute to chest pain, necessitating further evaluation.
Impact:
- Improved diagnostic accuracy for patients with unexplained chest pain.
- Reduced unnecessary cardiac investigations and associated healthcare costs.
- Enhanced understanding of the pathophysiology of functional esophageal disorders and their clinical manifestations.
Abstract:
The explantation of the cause of recurrent chest pain may be a considerable problem. In the first place coronary heart disease should be excluded. classical anginal pain features do not determine unequivocally its cause. One third of patients with anginal pain have normal coronarograms. Patients with chest pain of unexplained origin are a serious clinical problem. Recently, more attention has been paid to the possible role of functional oesophageal disturbances in such symptoms. Gastro-oesophageal reflux and abnormalities in motor function such as "nutcracker oesophagus", diffuse oesophageal oontraction, conditions of increased lower oesophageal sphincter tonus, or non-specific disturbances of motor function may be the cause of pain even of anginal character. However, both reflux and oesophageal motor function disturbances are frequently observed in healthy persons without could be the cause of chest pain. Confirmation of the connection between the symptoms and oesophageal disturbances may require the application not only of X-ray examinations and endoscopy but also manometric and pH-metric examinations and challenge tests (intraoesophageal balloon inflation, test with edrophonium, Bernstein test). Simultaneous monitoring of pH and pressures in the oesophagus during many hours seems to be particularly useful. An important role in the pathophysiology of chest pain may be played by abnormal perception of visceral stimuli ("irritable oesophagus")-so it is useful to supplement the studies with psychological tests.