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Query: UMLS:C0017168 (gastroesophageal reflux disease)
 11,783 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

During the session on diagnostic testing, various diagnostic tests used to identify the cause of chest pain were discussed. This critique of diagnostic assessments of the complex etiology of chest pain is presented as a contribution toward further investigation and clarification of this difficult clinical syndrome. The first step in the evaluation process is to exclude coronary artery disease. Patients with angina and normal coronary artery flow may have atypical disease, such as microvascular angina or syndrome X. The precise relationship between these disorders and esophageal disease or gastroesophageal reflux, as well as their possible involvement in chest pain of undetermined origin, requires further definition. A limitation of esophageal provocation tests is that they may identify the esophagus as the source of pain without determining the specific esophageal disorder that causes the pain. Problems associated with 24-hour pH and pressure monitoring include (a) poor correlation between reflux episodes and heartburn symptoms, (b) the lack of a good functioning swallowing signal, and (c) the huge amount of data that must be analyzed, along with shortcomings in computer-aided analysis. Nevertheless, the various available diagnostic tests can provide important information to the clinician.
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PMID:Critique of the session on diagnostic testing. 159 70

Angina-like chest pain in patients with coronary arteriography raises difficult diagnostic problems. The pain may be due to microvascular angina (or syndrome X). It is postulated that during the typical angina of these patients, the ST segment shifts on exercise electrocardiogram and the abnormal electrophysiologic tests on cardiac catheterisation are due to a decreased coronary flow reserve related to microvascular abnormalities. Angina-like chest pain may also be of oesophageal origin. Gastro-oesophageal reflux and oesophageal motility disorders are the two commonest oesophageal abnormalities held responsible for the pain. Recent observations suggest that sensitivity of the oesophagus to several stimuli may be another important cause of chest pain of oesophageal origin. This condition is called irritable oesophagus. Twenty-four hour pH- and pressure-recording is at present the best way to reach a specific diagnosis about the nature of the oesophageal abnormality.
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PMID:Gastro-oesophageal reflux disease, an important cause of angina-like chest pain. 269 37

To assess whether gastrointestinal factors can cause chest pain ("linked angina"), we studied the effect of oesophageal stimulation with acid on coronary blood flow in 20 syndrome X patients. Coronary blood flow velocity (CBFV) was measured with an intracoronary doppler catheter positioned in the proximal left anterior descending coronary artery. Acid stimulation produced typical anginal pain in 11 patients. Mean CBFV was significantly reduced from 7.3 (SD 4.0) to 4.4 (2.8) cm/s. Gastro-oesophageal reflux leading to reduced coronary blood flow may be a mechanism to explain linked angina.
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PMID:Effect of oesophageal acid instillation on coronary blood flow. 809 50

The epidemiology of NCCP is poorly described, and the available data are conflicting. Population-based studies on the prevalence of NCCP are rare; most studies have been hospital based. According to the limited studies available, the annual prevalence of NCCP is approximately 25%. Despite this significant burden, the impact and natural history of NCCP in the community has not been adequately explored. NCCP is presumed to bea heterogeneous condition. Hospital-based studies have suggested that GERD, esophageal spasm, psychiatric disease (including panic attacks), and musculoskeletal pain explain many cases of NCCP. However, unrecognized coronary artery disease and microvascular angina (cardiac syndrome X)also explain an unknown proportion of cases in the general population.Current studies suggest that NCCP is common in the general population and significantly affects QOL, yet only a minority seeks medical attention.The epidemiology of NCCP requires further study in the general population and in those attending the Emergency Department.
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PMID:Noncardiac chest pain: epidemiology, natural history, health care seeking, and quality of life. 1506 33

Management of patients with coronary artery disease is a major challenge for physicians, patients, and the healthcare system. Chest pain experienced by patients with coronary disease can be of noncardiac origin, and symptoms frequently related to gastroesophageal etiologies. The distal esophagus and the heart share a common afferent nerve supply, suggesting that location and radiation of perceived pain may be identical. In addition, there is substantial overlap between the prevalence of coronary disease and gastroesophageal reflux disease. Many physicians, including cardiologists, prescribe acid-reducing therapy to coronary patients. However, no prospective, randomized studies to date have evaluated the potential benefit of such treatments to prevent chest pain symptoms for these patients. We review the studies on noncardiac chest pain demonstrating reflux in patients with and without coronary disease. Also, the association of reflux with exertional chest pain and cardiac syndrome X is discussed. A rationale is presented for prevention of noncardiac chest pain in coronary patients, and the potential role of acid-suppressive therapy in managing these patients is discussed.
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PMID:Chest pain from gastroesophageal reflux disease in patients with coronary artery disease. 1594 50