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Query: UMLS:C0002962 (angina)
 21,142 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Blood flow disturbances in the gastrointestinal tract can lead to serious illness. They can be acute or chronic, their cause may be arterial or venous occlusion or hypotonia. Lesions of the gastrointestinal tract caused by ischemia depend on localisation, acuteness and degree of the blood flow disturbance. They may reach from focal and segmental ischemic lesions to extensive necroses of the entire intestinal tubes. The most serious ischemic disease is the embolic and thrombotic occlusion of the arteria mesenterica superior due to previous arterosclerotic damage. Infarction of a large part of the intestines and peritonitis can be the consequence. These patients' only chance of survival is early diagnosis--as a rule exclusively via angiography--and immediate surgery. Chronic occlusion of the arteria mesenterica superior leads to angina abdominalis which mainly occurs after food intake and can last for hours. The reason may also be a general arteriosclerosis. Men are affected more frequently and at a younger age than women. As a consequence of lowered intestinal blood flow these patients suffer from malabsorption and heavy weight loss. Conservative therapy is not effective. These patients, too, will have to be treated surgically after previous angiography. Vascular disease with decreased blood flow as its consequence can be found in a number of inflammatory diseases, in malign hypertensian, in collagen disease and in other more rare diseases as pseudoxanthoma elasticum or Ehlers-Danlos-syndrome. In the case of ischemic colitis arterial and more rarely venous occlusions cause decreased blood flow in the big bowel. A frequent consequence is colitis in the left colon which is characterized by acuteness, pain in the left side of the abdomen and by heavy rectal bleeding. Diagnosis is established by means of endoscopy, barium enema and angiography. Primarily therapy of ischemic colitis is of the conservative type. In severe cases with gangrene and peritonitis the colon has to be resected.
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PMID:[Disorders of the blood circulation in the gastrointestinal tract]. 32 26

Esophageal motility disorders are now known to be a heterogeneous group of conditions that commonly cause dysphagia and chest pain. Motor dysphagia is usually provoked by solids and liquids (in contrast to mechanical dysphagia, which is usually provoked by solids only). Chest pain with these disorders is nonspecific and can mimic angina pectoris. In many patients with diffuse esophageal spasm or nutcracker esophagus, pain appears to be caused by abnormal sensory function rather than contraction abnormalities. Barium esophagography and esophageal manometry are complementary studies in the evaluation of motility disorders.
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PMID:Diagnosis of esophageal motility disorders. 239 4

We reviewed 123 consecutive patients who underwent esophageal function testing to determine the prevalence and clinical characteristics of the syndrome of high-amplitude peristaltic contractions (HAPC). Twenty-eight patients (23%) were found to have HAPC, including 16 males and 12 females with a median age of 54 years. Barium esophograms yielded no evidence of motility disorders, while 35% of those tested had pathologic gastroesophageal acid reflux. Twenty (71%) were initially referred for evaluation of angina-like chest pain, and 8 were referred with other symptoms. Of those with chest pain, 19 initially underwent extensive evaluation for coronary artery disease before the diagnosis of HAPC. Symptoms of heartburn, regurgitation, and dysphagia were absent or minimal in most patients. Lower esophageal sphincter pressure was normal in 27 patients, and lower esophageal sphincter relaxation was normal in all patients. Mean distal esophageal peak peristaltic pressure was 147.8 mm Hg, while the highest peak peristaltic pressure for each patient averaged 193.2 mm Hg. Seven patients had mean peristaltic wave durations of more than 7 seconds. Patients with atypical chest pain or those with typical angina in whom coronary artery disease is eliminated as a possible cause should be evaluated for HAPC with esophageal manometry. Patients with symptoms are usually successfully treated with smooth muscle relaxants, and surgical intervention is rarely necessary.
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PMID:Angina-like chest pain associated with high-amplitude peristaltic contractions of the esophagus. 317 68

We prospectively evaluated 22 patients with manometrically proven "nutcracker esophagus" (high amplitude peristaltic contractions). All patients were symptomatic with angina-like chest pain, dysphagia, or both. Patients underwent barium esophagram with video-recording of the images. Video tapes were reviewed independently by a gastrointestinal radiologist who was unaware of the patients' manometric diagnoses. The video-esophagram was normal in 12 of 22 (55%) patients. Eight of 22 (36%) had dysmotility: either diffuse spasm (9%) or tertiary contractions (27%) (Fig. 2). A hiatal hernia was the only abnormality in two patients. Although the presence of diffuse spasm or tertiary contractions may suggest the presence of the underlying motor disorder in patients with nutcracker esophagus, we conclude that the "barium swallow" lacks sufficient sensitivity to screen adequately for this disorder in patients with atypical angina or dysphagia.
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PMID:Radiology of the nutcracker esophagus. 373 53

A 27-year-old black woman with cardiac failure, angina pectoris and Raynaud's syndrome is presented. Skin biopsy and barium studies established the diagnosis of scleroderma (progressive systemic sclerosis (PSS)). Systemic lupus erythematosus (SLE) was strongly suggested by the results of immunological studies and increasing severity of renal failure. Because of the possibility of a cardiomyopathy, cardiac catheterization, selective coronary angiography and right ventricular endomyocardial biopsy were carried out but failed to show any histological features of either SLE or PSS. The patient went into progressive renal failure despite immunosuppressive therapy and plasmapheresis and died; consent for autopsy was refused. A final diagnosis of mixed connective tissue disease (MCTD) was made. The salient features of cardiac involvement in SLE, PSS and MCTD are outlined.
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PMID:Cardiac involvement in mixed connective tissue disease. A fatal case of scleroderma combined with systemic lupus erythematosus. 406 33

Angina-like chest pain frequently arises from the esophagus. However, when a patient has chest pain, the gravity of possible myocardial ischemia indicates that a cardiac workup must be done. Those individuals with typical anginal pain who have normal multistage exercise tests or normal coronary arteriograms and any person with atypical chest pain should be thoroughly evaluated for esophageal disease. This evaluation should include a barium swallow, a Bernstein test, esophageal manometry, and, if indicated, esophagoscopy. Reproduction of the chest pain with the Bernstein test incriminates gastroesophageal reflux disease. Esophageal manometry is required to make the diagnoses of achalasis, DES, and hypertensive LES or esophageal body (Table 1).
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PMID:Chest pain: differentiating esophageal disease from angina pectoris. 716 Jan 64

To assess the frequency of esophageal disease in patients with angina-like chest pain and normal coronary arteriograms, 16 patients underwent esophageal manometric studies, acid perfusion (Bernstein) tests, upper gastrointestinal series and cholecystograms. Five patients had evidence of esophageal diseases. Three of the five had manometric criteria of increased nonperistalsis; one patient had idiopathic diffuse esophageal spasm while the other two patients had acid infusion tests which reproduced the presenting chest pain and the manometric findings were regarded as a motor disturbance of the esophagus secondary to chronic gastroesophageal reflux. The remaining two patients had symptomatic gastroesophageal reflux--one with an acid infusion test positive for pressure like chest pain and the other with a decreased resting lower esophageal sphincter pressure associated with reflux of barium on upper gastrointestinal series. All five patients had improvement of symptoms during a follow up period of seven to 17 months. Manometric studies in 18 normal subjects of similar age revealed no evidence of esophageal disease. Since esophageal disorders capable of causing chest pain were diagnosed in one-third of the patients (5/16 or 31%), it is suggested that investigations for esophageal disease, specifically directed at gastroesophageal reflux-induced abnormalities and idiopathic diffuse esophageal spasm, be included in the evaluation of patients with angina-like chest pain of uncertain origin.
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PMID:Esophageal disease in patients with angina-like chest pain. 723 36

Heartburn, suggesting gastroesophageal reflux, is common. Epidemiological studies have shown that 36% to 44% of adults experience heartburn at least once a month, 14% weekly and 7% once a day. Heartburn and regurgitations are the typical symptoms of gastroesophageal reflux disease (GERD). When present as predominant symptoms, they are quite specific but not very sensitive. Clinical severity of GERD does not predict the severity of the underlying condition. The diagnostic approach to patients with GERD depends on the clinical presentation and the question to be answered -Is abnormal reflux present? Is there mucosal injury? Are symptoms due to reflux? Several techniques such as barium swallow, endoscopy, ambulatory pH monitoring, esophageal manometry and 24 h pH/motility can be used to answer those questions. Barium swallow is not much help in diagnosing reflux esophagitis because reflux can occur in more than 25% of asymptomatic patients. It is most useful in demonstrating structural abnormalities such as strictures and hiatal hernia. The importance of hiatal hernia in the pathogenesis of GERD has been controversial. Recent studies suggest that GERD patients with hiatal hernia present with greater extent of reflux and more severe esophagitis. Endoscopy is the best diagnostic study for mucosal evaluation. Ambulatory 24 h pH monitoring is indicated for patients with atypical symptoms of reflux such as chest pain or pulmonary symptoms, or those who do no respond to therapy. The evaluation of duodenogastroesophageal reflux or alkaline reflux can be measured, but the clinical importance of this test remains controversial. Esophageal manometry allows measurement of the lower esophageal sphincter pressure (LES) and the evaluation of esophageal peristalsis. There is a lack of correlation between LES and reflux esophagitis. The role of peristaltic dysfunction in GERD is unclear, but the high percentage of abnormal contractions suggests a more severe form of GERD. Esophageal motility study can document the presence of effective esophageal peristalsis in patients before antireflux surgery. Twenty-four hour pH/motility is not yet available widely. It is useful in patients who have several daily attacks. There is a correlation with acid reflux in approximately 40% of events. Investigation of noncardiac angina-like chest pain is best achieved by standard esophageal manometry combined with provocative testing. Most laboratories performing these studies use acid perfusion and pharmacostimulation with either bethanechol or edrophonium to reproduce the patient's chest pain during esophageal manometry. Esophageal balloon distension is considered to give the highest yield as a provocative test in patients with angina-like chest pain. It is believed that abnormal esophageal nociception is not simply related to underlying motor dysfunction but also to the presence of a visceral sensory abnormality.
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PMID:Assessment of clinical severity and investigation of uncomplicated gastroesophageal reflux disease and noncardiac angina-like chest pain. 934 76

Gastroesophageal reflux disease (GERD) can be described as a clinical picture resulting from the reflux of stomach contents into the esophagus. The actual prevalence of GERD remains unestablished, although this disorder is generally common in old patients, male sex and in subsets of patients with pulmonary manifestations such as asthma. From a pathophysiological stand-point, GERD is thought to have a multifactorial etiology which involves genetics, anatomical, functional, environmental, hormonal and pharmacological factors. GERD has different clinical presentations which may be divided in three main classes: typical symptoms (heartburn and regurgitation); atypical or extraesophageal symptoms (angina-like chest pain, asthma, chronic cough and laryngitis); and complications (ulcers, strictures and Barrett's esophagus). In GERD diagnosis a key role is played by: accurate symptom evaluation, response to proton pump inhibitors and, finally, at least one in a life-time endoscopy. Moreover, barium swallow X-ray, 24-h esophageal pH monitoring and gastro-esophageal manometry can be useful to support diagnosis in some unusual cases or in cases partially or unresponsive to standard pharmacologic treatment.
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PMID:[Gastroesophageal reflux disease: clinical and pathophysiological features (part I)]. 1740 61