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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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The Journal of Cardiovascular Surgery 2002 August;43(4):553-7

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

The role of gastroesophageal reflux disease in chest pain

Pellicano R., Durazzo M. 1, Oliaro E. 2, Fagoonee S. 3, Oliaro A. 4, Rizzetto M.

UOADU Gastro-Hepatology Molinette Hospital, Turin, Italy 1 Department of Internal Medicine 2 Department of Cardiology 3 Department of Biology, Genetic and Biochemistry 4 Department of Thoracic Surgery University of Turin, Turin, Italy


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Gastroesophageal ­reflux dis­ease (­GERD) is ­thought to ­play an impor­tant ­role in ­the path­o­gen­e­sis of ­non-car­diac, unex­plained, ­chest ­pain. The phys­io­path­o­log­i­cal mech­a­nism of ­this extrae­soph­a­geal man­i­fes­ta­tion, ­remains ­unclear ­but it is sup­posed ­that ­the ­ache ­could be trig­gered by ­the stim­u­la­tion of ­acid-sen­si­tive noc­i­cep­tors of ­the muco­sa. The esoph­a­geal ori­gin of ­the symp­tom ­may be iden­ti­fied by an empir­ic ­trial of ­high-­dose anti­se­cre­to­ry ­drugs or an abnor­mal pro­longed ambu­la­to­ry pH mon­i­tor­ing ­study. Less impor­tant is ­the ­role of endos­co­py espe­cial­ly in sub­jects with­out typ­i­cal symp­toms of ­GERD. The ­use of manom­e­try or pro­voc­a­tive ­tests ­can con­sent to eval­u­ate ­for esoph­a­geal motil­ity abnor­mal­ities. It is gen­er­al­ly accept­ed ­that in clin­i­cal prac­tice, in ­patients ­with ­non-car­diac ­chest ­pain, ­the admin­is­tra­tion of pro­ton ­pump inhib­i­tors, ­could ­serve as a ­first ­approach. It is ­cost-effec­tive in ­the ­short-­term peri­od, ­when com­pared ­with inves­ti­ga­tion ­for gas­troin­tes­ti­nal caus­es, ­with ­cost sav­ings per­sist­ing ­beyond a ­year. In con­clu­sion, ­patients ­with ­non-car­diac ­chest ­pain of ­unknown ori­gin ­should be care­ful­ly ­screened ­for ­the occur­rence of ­GERD, ­but fur­ther ­research is need­ed to clar­i­fy ­the ­role of ­the lat­ter on ­the path­o­gen­e­sis of ­this symp­tom.

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