Chest Pain of
Oesophageal Origin – Causes, Diagnosis and Therapeutic Possibilities
Bortlík M. 1 , Lukáš M. 1 , Šimek S. 2 , Novotný V. 3 , Tůma P. 3 , Novotný A. 1 ,
Adamec S. 1
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Summary:
Non-cardiac chest pain (NCCP) is an important clinical problem requiring co-operation between
cardiologist and gastroenterologist. Approximately, one half of the patients with NCCP suffer
from oesophageal disorders. In most cases, we can find gastroesophageal acid reflux, a minor part
is formed by patients with oesophageal dysmotility or „irritable oesophagus“. As regards the
diagnostic approach in patients with NCCP, we suggest long-term esophageal pH and pressure
monitoring as the most important technique, sometimes we use provocative tests. The crucial
point of evaluating pH- and manometry is time-related occurrence of pain episodes and pH or
motility disturbances. This time-relation is expressed by the symptom index. The authors also
present their own results from a group of 63 patients with non-cardiac chest pain, examined by
upper endoscopy, oesophageal pH and pressure monitoring and provocative balloon test. In
49.2 % patients an oesophageal origin of the complaints was found. Therapy of the Nccp patients
should be targeted causally. It consists of the dietary and regime measures and administration of
antisecretory drugs, spasmolytics, prokinetics, and in some cases, anxiolytics. Correct diagnosis
and effective treatment of non-cardiac chest pain seems to be also cost-effective.
Key words:
non-cardiac chest pain – oesophageal pH-monitoring – manometry – gastroesopha-
geal reflux – oesophageal motility disturbances – irritable oesophagus
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