[Thoracic pain of oesophageal origin. Diagnostic management and treatment].
FROM AN ETIOLOGICAL POINT OF VIEW: Thoracic pain is a frequent symptom. Before confirming the oesophageal origin of the pain, a coronary disease must be excluded. Two principle causes are source of thoracic pain of oesophageal origin: gastro-oesophageal reflux disease and oesophageal motility abnormalities. THE DIAGNOSTIC APPROACH: This must include the questioning of the patient and the usual paraclinical examinations. To confirm the diagnosis, these examinations must establish a chronological relationship between the symptoms and the abnormalities. For economic reasons, following a normal gastroscopy, there is a tendency to propose an empirical proton pump inhibitor (PPI) test rather than a 24 hour pH-metry antireflux as first line. The improvement or even the disappearance of the symptoms confirms the diagnosis; long-term treatment with a double dose of PPI should therefore be envisaged. The pH-metry with search for results should be proposed to the non-responders and to patients with atypical reflux manifestations. Dysphagia and odynophagia suggest an oesophageal motility disorder that basal manometry should confirm. A chronological relationship is rarely revealed, but the sensitivity of the pH-meter can be enhanced by provocation tests. REGARDING TREATMENT: Other than achalasia, treatment of the other spastic-like motor disorders is not well codified. Diltiazem is efficient. Some patients exhibit a hyperalgic oesophagus. The physiopathological mechanisms are still theoretical. Low dose tricyclic antidepressors and psychological management are useful.
Bronstein
Jean-Ariel
JA
Service de pathologie digestive, Hôpital d'Instruction des Armées de Brest, Brest Naval.
Caumes
Jean-Luc
JL
Richecoeur
Martial
M
Lipovac
Anne-Sylvie
AS
D002121:Calcium Channel Blockers / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004110:Diltiazem / Q000627:therapeutic use; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D015154:Esophageal Motility Disorders / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D005773:Gastroscopy; D006801:Humans; D008365:Manometry; D010146:Pain / Q000209:etiology*; D054328:Proton Pump Inhibitors; D013909:Thorax
D002121:Calcium Channel Blockers; D004791:Enzyme Inhibitors; D054328:Proton Pump Inhibitors; D004110:Diltiazem