[Approach to thoracic pain from the gastroenterologist's point of view].
Chest pain is common in medical consultations. One of the most frequent and serious causes is acute ischemic heart disease, which must be ruled out. The gold standard is coronary angiography. Noncardiac recurrent chest pain has a favorable prognosis. The most frequent cause is esophageal disease, with a prevalence of between 20% and 50%. The most frequent form is gastroesophageal reflux disease followed by esophageal motor disorders. Empirical treatment with high-dose proton pump inhibitors should be considered as a diagnostic-therapeutic test before performing exhaustive complementary investigations of esophageal function. Among complementary tests, manometry combined with 24-hour pH-metry has the highest diagnostic yield. Antidepressants are an acceptable therapeutic option in patients with esophageal visceral hyperalgesia.
Ortiz Bellver
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Servicio de Medicina Digestiva, Hospital Universitario La Fe, Avda. Campanar 21, 46009 Valencia, Spain.
Garrigues Gil
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D002637:Chest Pain / Q000175:diagnosis / Q000209:etiology*; D003937:Diagnosis, Differential; D004935:Esophageal Diseases / Q000150:complications* / Q000175:diagnosis; D006801:Humans