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ULTIMO FASCICOLOTHE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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

THORACIC SECTION 

 REVIEW ARTICLES

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

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.

lingua: Inglese


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