Esophageal chest pain

Introduction to esophageal chest pain Esophageal chest pain refers to chest pain caused by esophageal disease or esophageal dysfunction. The typical symptoms are heartburn with post-sternal or substernal paroxysmal pain, which is squeezed or burned, and occurs more often 30 to 60 minutes after a meal. Similar to "angina", irritating food, exercise, emotional stress can be induced, but also spontaneous attacks. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: difficulty swallowing

Causes of esophageal chest pain

(1) Causes of the disease

1. Gastroesophageal reflux (GER) and reflux esophagitis (RE) are the most common causes of esophageal chest pain.

2. Esophageal dysmotility includes high-amplitude peristaltic contraction of the esophagus, "nutcracker" esophagus, diffuse esophageal fistula, achalasia, high-pressure esophageal sphincter and some non-specific esophageal movement abnormalities.

(two) pathogenesis

1. Mechanism of acid reflux causing chest pain

(1) The reflux of acidic contents on the esophageal mucosa, nerves, muscles, and secondary esophageal movement abnormalities, leading to chest pain.

(2) Super sensitive esophagus (SSE), mainly expressed in the hypersensitivity of the esophagus to mechanical expansion, increased sensitivity to acid sensitivity and pain.

2. Esophageal fistula can produce angina pectoris-like chest pain, which can be accompanied by dysphagia, which occurs after eating or eating. It can also occur during exercise or emotional stress. The pain is located behind the sternum or under the sternum, to the shoulder. Radiation on the back.

Esophageal chest pain prevention

Or diet-based, it is best to eat foods that are easy to digest, so that patients can not absorb.

Complications of esophageal chest pain Complications, difficulty swallowing

Non-cardiac chest pain.

Symptoms of esophageal chest pain Common symptoms Dull pain and anxiety caused by chest pain, swallowing, heartburn, chest pain, abdominal pain, difficulty breathing

Chest pain

The characteristics of esophageal chest pain are very similar to those of "angina pectoris". It is characterized by squeezing cramps behind the sternum or under the xiphoid. If it is caused by reflux esophagitis, it can be burnt-like pain, but also dull pain, pain. Can be radiated to the lower jaw, neck, upper limbs or back. Some patients have painful episodes related to eating, physical activity and body position (such as lying position and bending). Some patients have oral antacid and nitroglycerin pain relief, esophageal chest pain. Patients with chest pain can be spontaneous, such as diffuse esophageal fistula, reflux esophagitis patients have night regurgitation, so chest pain often occurs at night, should be noted with "variant angina" identification.

2. Esophageal syndrome

Including heartburn, acid reflux, burning in the upper abdomen, difficulty in swallowing or swallowing pain, etc., the severity of the symptoms is related to the primary disease, such as diffuse esophageal fistula, patients have more eating pain, convulsions, eating irritating food can induce .

3. Esophageal syndrome

Secondary esophageal chest pain secondary to gastroesophageal reflux, when the nighttime reflux is severe, inhalation leads to chronic pulmonary bronchial disease, the patient complained of cough, cough and dyspnea or asthma, patients with hiatal hernia, chest pain is typical and often Sexually, when incarcerated, vomiting, abdominal pain, spontaneous esophageal rupture, chest pain, suffocation, sudden death, and may be accompanied by breathing, pulse acceleration and shock, these symptoms and signs of the esophageal and systemic, not only provide The clues of esophageal source factors are also important identification points for cardiogenic chest pain.

Examination of esophageal chest pain

Patients with recurrent sternal or substernal pain should first undergo cardiac examination. Conventional electrocardiogram, exercise test, etc. are not enough. Coronary angiography must be performed. If there is no positive finding, it should be considered whether there is esophageal factor. Esophageal barium angiography is also a routine screening test. Suspected people can perform endoscopy to determine whether the esophagus has esophagitis, tumors and hiatal hernia.

1.24h esophageal pH monitoring

The portable 24-hour esophageal pH monitoring method can continuously monitor the changes of esophageal pH, and can be combined with the analysis of chest pain to determine whether the chest pain episode is related to esophageal acid reflux.

2. Esophageal pressure measuring esophageal manometry

It is an important means for diagnosing abnormal esophageal motility. Whether it is perfusion or balloon pressure measurement, it can diagnose esophageal abnormalities. The continuous 24h esophageal continuous pressure measuring device, especially with the esophageal pH monitoring synchronous recorder, is more extensive. For the diagnosis of esophageal chest pain, especially for esophageal dysfunction, such as diffuse esophageal fistula, achalasia and abnormal esophageal motility, esophageal manometry is an important means of detection, as well as for chest pain and abnormal esophageal motility. The relationship is fully evaluated and analyzed.

3.Bernstein acid perfusion test

For example, the acid perfusion test stimulates the onset of angina pectoris-like chest pain, while the saline perfusion does not induce chest pain, which is positive for the test, suggesting esophageal chest pain.

4. Airbag expansion test

Using the balloon to dilate the lower esophagus, 60% of patients with esophageal chest pain induced chest pain, while only 20% of the normal group had chest pain, and the minimum expansion volume of NCCP patients who received chest pain was significantly lower than that of the normal group.

Not every patient suspected of esophageal chest pain needs to perform the above-mentioned tests. According to the clinical characteristics, the necessary examination methods should be selected to determine the etiology of esophageal aspects of chest pain and the treatment mode of esophageal chest pain.

Diagnosis and differentiation of esophageal chest pain

Diagnostic criteria

1. Clinical features of esophageal chest pain

(1) It is related to gender and age. Male is higher than female, male: female is 2:1, and the peak age of onset is 50 years old.

(2) The pain is often attacked or aggravated when swallowing. It often occurs 1 hour after a meal and lasts for 4 to 5 minutes to radiate to the shoulder.

(3) Pain is often located behind the sternum. Redel et al have shown that most patients with esophageal fistula or gastroesophage have chest pain, 39% are behind the sternum, 35% are under the xiphoid process, and 1/3 of the patients are radiating to the back. The latter may be an important clue to the identification of angina.

(4) Other symptoms often associated with esophageal diseases such as non-progressive dysphagia, heartburn, acid reflux and nocturnal reflux.

(5) Chest pain associated with esophageal morphological lesions, in addition to chest pain, there are more obvious digestive symptoms; chest pain associated with esophageal dyskinesia, in addition to chest pain, some patients lack obvious digestive symptoms.

2. Diagnostic procedures

Esophageal chest pain must be combined with clinical manifestations and various examination methods in order to make a correct etiological diagnosis. For patients with recurrent post-sternal or substernal pain, first a cardiovascular examination should be performed to rule out heart disease, and then Routine esophageal barium angiography and endoscopy were performed to determine whether the esophagus had functional or structural abnormalities. Special monitoring of esophageal dynamics was performed when necessary. The causal relationship between chest pain and esophageal abnormalities was difficult to establish in some patients. Therefore, an excitation test was needed. In order to improve the positive detection rate, a joint examination can be performed. Richter reported 910 patients with non-cardiac chest pain, single esophageal manometry, eosinogenicity detected by phenol chloride (Tengxilong) test and acid drop test. The positive rates of chest pain were 28%, 23% and 7%, respectively. The positive detection rate of combined examination was 48%, which was significantly better than the former.

Differential diagnosis

1. Cardiac chest pain The symptoms of esophageal chest pain are similar to "angina pectoris". Therefore, it is necessary to first carry out cardiovascular examinations, including electrocardiogram and exercise test and coronary angiography. Most of the cardiogenic chest pain can be detected by the above examination. Diagnosis, but some patients can not completely rule out hidden cardiovascular factors, such as Prinzmetals vasospasm and microvascular angina or syndrome X, even if coronary angiography is completely normal.

(1) Characteristics of Prinzmetal vasospasm: chest pain is atypical, not related to physical activity, often occurs before getting up in the morning, and ECG shows ST segment elevation.

(2) Chest pain in syndrome X is caused by decreased cardiac microcirculation expansion or decreased blood flow reserve of cardiac microcirculation. Diagnosis of the above diseases often requires cardiac catheterization, vena cava blood flow measurement and ergometrine, dipyridamole. (Pan Shengding) Invasive tests such as drug-induced tests.

2. Aortic-derived chest pain is seen in aortic dissection and saccular aortic aneurysm. Aortic dissection is mostly in men with hypertension of 40 to 70 years old. Chest pain is similar to myocardial infarction. Sudden pain, severe, tearing Sexuality, a wide range, bilateral iliac artery pulsation is significantly different, the upper limbs blood pressure is also different, X-ray examination shows aortic widening, double wall contour caused by false sac, B-ultrasound, CT examination and aortic angiography can be determined Diagnosis, cystic aortic aneurysm is rare, history, X-ray examination and angiography can make a diagnosis.

3. Pulmonary chest pain is seen in pulmonary embolism and pneumothorax. Pulmonary embolism occurs in patients over 40 years old. It can cause chest pain, dyspnea and electrocardiogram changes in the early stage of the disease. Pleural friction or X-ray examination reveals pulmonary infiltration or a small amount of pleural effusion. The fluid is helpful for diagnosis. Spontaneous pneumothorax can cause severe knife-like chest pain, accompanied by post-sternal pressure or chest tightness, and sudden dyspnea is a feature. X-ray examination is helpful for diagnosis.

4. Biliary tract disease Acute biliary tract disease can cause chest pain in myocardial infarction. Chronic cholecystitis causes recurrent episodes of mild pain in the lower chest and upper abdomen. Sometimes the nature and location of pain are similar to angina pectoris. B-ultrasound, CT examination and cholangiography are helpful. Differential diagnosis.

5. Herpes zoster can cause severe chest pain, but the location is consistent with the intercostal nerve distribution, and herpes or blisters can be found during physical examination.

6. Lower cervical intervertebral disc prolapse The disease often causes nerve roots to cause chest pain. Pain is related to certain movements and postures, such as bending over, turning or licking for too long, etc., coughing, sneezing, deep breathing or forced bowel movements The pain occurs after a few hours of rest in the supine position, often causing the patient to wake up from sleep, history, X-ray and CT examinations are helpful for diagnosis.

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