medigraphic.com
Asociación Mexicana de Gastroenterología

2007, Number 2

<< Back Next >>

Rev Gastroenterol Mex 2007; 72 (2)

Causes of non-cardiac chest pain: Multidisciplinary Perspective

Ortiz-Olvera NX, González-Martínez M, Ruiz-Flores LG, Blancas-Valencia JM, Morán-Villota S, Dehesa-Violante M

Language: Spanish
References: 36
Page: 92-99
PDF size: 57.84 Kb.


ABSTRACT

Background: Non-cardiac chest pain (NCCP) is defined by recurrent episodes of substernal chest pain non related to ischemic heart disease, it’s origin being in many cases the gastrointestinal tract; however, it may be associated to psychosomatic disorder. Objectives: To investigate the main causes of NCCP and to evaluate associated psychiatric comorbidity. Methods: Patients with NCCP referred by a cardiologist were assessed underwent an upper endoscopy, ambulatory pH monitoring and stationary esophageal manometry. NCCP was considered gastro esophageal reflux disease (GERD) positive when the endoscopy and/or ambulatory pH monitoring were abnormal. When all results were normal, the symptom was considered as a functional chest pain (FCP). Patients were assessed by the Psychiatry service and diagnosed in accordance to the Diagnostic and Statistics Manual of Mental Diseases, fourth edition (DSM-IV). Several other test were applied for the assessment of anxiety and depression. Results: Thirty-four patients were included (25 women and nine men; average age: 46.2 ± 11.56 years). Three patients were eliminated because of refusal of the psychiatric evaluation. In 21 (68%) patients, NCCP was GERD-positive and in 10 (32%) to FCP. The most common symptoms associated to chest pain were: heartburn in 23 (74%), regurgitation in 21 (68%) and dysphagia in 15 (48%) patients. Upper endoscopy was abnormal in four cases; ambulatory pH monitoring was abnormal in 21 (67.7%) patients. The frequency of psychiatric disorders related to NCCP was 52%, in 10 patients with GERD-positive (48%) and six patients with FCP (60%). Mayor depression was the most common diagnoses identified among both groups. Conclusion: The high frequency of GERD and psychiatric disorders found in NCCP supports the multidisciplinary approach to NCCP.


REFERENCES

  1. Sheps DS. Chest pain in patients with cardiac and noncardiac disease. Psychosomatic Medicine 2004; 66: 861-7.

  2. Eslick GD. Noncardiac chest pain: epidemiology, natural history, health care seeking, and quality of life. Gastroenterol Clin N Am 2004; 33: 1-23.

  3. Locke GR III, Talley NJ, Fett SL, et al. Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Olmstead country, Minnesota. Gastroenterol 1997; 112: 1448-56.

  4. Botoman VA. Noncardiac chest pain. J Clin Gastroenterol 2002; 34(1): 6-14.

  5. Rao SSC, Mudipalli RS. An open-label trial of theophylline for functional chest pain. Digestive Diseases and Sciences 2002; 47(12): 2763-8.

  6. Clouse RE, Richter JE. Functional esophageal disorders. Gut 1999; 45: II31-II36.

  7. Olden KW. The psychological aspects of noncardiac chest pain. Gastroenterol Clin N Am 2004; 33: 61-7.

  8. Clouse RE, Richter JE, Heading RC, et al. Functional esophageal disorders. In: Drossman AD, Corazziari E, Talley NJ, Thompson WG, Whitehead WE (eds.). Rome II: The functional gastrointestinal disorders. McLean, VA: Degnon Associates; 2000, p. 247-98.

  9. Dickman R, Fass R. Noncardiac chest pain. Clinical Gastroenterol and Hepatol 2006; 4: 558-63.

  10. Weiner GJ, Morgan TM. Ambulatory 24-hour esophageal pH monitoring, reproducibility and variability of pH parameters. Dig Dis Sci 1998; 33: 1127-33.

  11. Sivak Jr, MV. Technique of upper gastrointestinal endoscopy. In: Gastroenterologic Endoscopy. Philadelphia: WB Saunders; 1987, p. 272-95.

  12. Lundell L, Dent J, Bennet JR. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut 1999; 45: 172-80.

  13. Castell JA, Gideon RM, Castell DO. Esophagus. In: Atlas of Gastrointestinal Motility. Marvin M. Schuster (eds.). Baltimore, Maryland: Williams & Wilkins; 1993, p. 134-57.

  14. Spechler SJ, Castell DO. Classification of oesophageal motility abnormalities. Gut 2001; 49: 145-51.

  15. Richter JE. Oesophageal motility disorders. Lancet 2001; 358: 823-8.

  16. Dekel R, Martinez-Hawthorne S, Guillen J, Fass R. Evaluation of symptom index in identifying gastroesophageal reflux disease-related noncardiac chest pain. J Clin Gastroenterol 2004; 38(1): 24-9.

  17. Sifrim D, Dupont L, Blondeau K, et al. Weakly acidic reflux in patients with chronic unexplained cough during 24 hour pressure, pH, and impedance monitoring. Gut 2005; 54: 449-54.

  18. Weusten B, Roelofs J, Akkermans L, et al. The symptom-association probability: An improved method for symptom analysis of 24-hour esophageal pH data. Gastroenterol 1994; 107: 1741-5.

  19. Sheehan DV, Lecubrier Y, Harnett-Sheehan K, et al. The MINI- International Neuropsychiatry Interview: The Development and Validation of a Structured Diagnostic Psychiatry Interview. J Clin Psychiatry 1998; 59: 22-3.

  20. Manual diagnóstico y estadístico de los trastornos mentales. 4a. Ed. Texto revisado (DSM-IV-TR), de la Asociación Americana de Psiquiatría. Barcelona, España: Edit. Masson; 2002.

  21. Williams J. A structured interview guide for the Hamilton Depression Rating Scale. Arch Gen Psychiatry 1988; 45: 742-7.

  22. Samson JA. Standardized psychiatric interviews. In: Jacobson (ed.). Psychiatric secrets. 2nd Ed. Copyright © 2001 Hanley and Belfus.

  23. Beck AT, Ward CH, Mendelson M, et al. An inventory for measuring depression. Arch Gen Psychiatry 1961; 4: 561-71.

  24. Jurado S, Villegas ME, Méndez L, et al. La estandarización del Inventario de Depresión de Beck para los residentes de la Ciudad de México. Salud Ment 1998; 21(3): 26-31.

  25. Wang WH, Huang JA, Zheng GF, et al. Is proton pump inhibitor testing an effective approach to diagnose gastroesophageal reflux disease in patients with noncardiac chest pain: a meta-analysis. Arch Intern Med 2005; 1222-8.

  26. Faybush E, Fass R. Gastroesophageal reflux disease in noncardiac chest pain. Gastroenterol Clin N Am 2004: 33; 41-54.

  27. Hewson EG, Sinclair JW, Dalton CB, Richter JE. Twenty-four-hour esophageal pH monitoring: the most useful test for evaluating noncardiac chest pain. Am J Med 1991; 90: 576-83.

  28. Dekel R, Martínez HSD, Guillen RJ, Fass R. Evaluation of symptoms index (SI) in identifying gastroesophageal reflux disease (GERD)-related noncardiac chest pain (NCCP). J Clin Gastroenterol 2004; 38: 24-9.

  29. Drossman DA, Li Z, Andruzzi E, et al. US Householder Survey of Functional Gastrointestinal Disorders: prevalence, sociodemography, and health impact. Dig Dis Sci 1993; 38: 1569-80.

  30. Medina MME, Borges G, Lara MC, et al. Prevalencia de trastornos mentales y uso de servicios: Resultados de la Encuesta Nacional de Epidemiología. Psiquiátrica en México. Salud Mental 2003; 26: 1-4.

  31. Narrow W, Rae D, Regier D. NIMH epidemiology note: prevalence of anxiety disorders. One-year prevalence best estimates calculated from ECA and NCS data. Population estimates based on U.S. Census estimated residential population age 18 to 54 on July 1; 1998.

  32. Levy RL, Orden KW, Naliboff BD, et al. Psychosocial aspects of the functional gastrointestinal disorders. Gastroenterol 2006; 130: 1447-58.

  33. Dammen T, Arneses H, Ekeberg O, Friis S. Psychological factors, pain attribution and medical morbidity in chest-pain patients with and without coronary artery disease. General Hospital Psychiatry 2004; 26: 463-9.

  34. Ho KY, Kang JY, Yeo B, Ng WL. Non-cardiac, non-oesophageal chest pain: the relevante of psychological factors. Gut 1998; 43: 105-10.

  35. Ockene IS, Shay MJ, Alpert JS, et al. Unexplained chest pain in patients with normal coronary arteriograms: a follow-up study of functional status. N Engl J Med 1980; 303: 1249-52.

  36. Galmiche JP, Clouse RE, Bálint A, et al. Functional esophageal disorders. Gastroenterol 2006; 130: 1459-65.




2020     |     www.medigraphic.com