[Causes of non-cardiac chest pain: multidisciplinary perspective].
BACKGROUND
Non-cardiac chest pain (NCCP) is defined by recurrent episodes of substernal chest pain non related to ischemic heart disease, it's origin being in many cases the gastrointestinal tract; however, it may be associated to psychosomatic disorder.


OBJECTIVE
To investigate the main causes of NCCP and to evaluate associated psychiatric comorbidity.


METHODS
Patients with NCCP referred by a cardiologist were assessed underwent an upper endoscopy, ambulatory pH monitoring and stationary esophageal manometry. NCCP was considered gastro esophageal reflux disease (GERD) positive when the endoscopy and/or ambulatory pH monitoring were abnormal. When all results were normal, the symptom was considered as a functional chest pain (FCP). Patients were assessed by the Psychiatry service and diagnosed in accordance to the Diagnostic and Statistics Manual of Mental Diseases, fourth edition (DSM-IV). Several other test were applied for the assessment of anxiety and depression.


RESULTS
Thirty-four patients were included (25 women and nine men; average age: 46.2 +/- 11.56 years). Three patients were eliminated because of refusal of the psychiatric evaluation. In 21 (68%) patients, NCCP was GERD-positive and in 10 (32%) to FCP. The most common symptoms associated to chest pain were: heartburn in 23 (74%), regurgitation in 21 (68%) and dysphagia in 15 (48%) patients. Upper endoscopy was abnormal in four cases; ambulatory pH monitoring was abnormal in 21 (67.7%) patients. The frequency of psychiatric disorders related to NCCP was 52%, in 10 patients with GERD-positive (48%) and six patients with FCP (60%). Mayor depression was the most common diagnoses identified among both groups.


CONCLUSIONS
The high frequency of GERD and psychiatric disorders found in NCCP supports the multidisciplinary approach to NCCP.
Ortiz-Olvera
Nayeli Xochiquetzal
NX
Universidad Autónoma del Estado de México, Servicio de Gastroenterología, Hospital de Especialidades Dr. Bernardo Sepúlveda, Centro Médico Nacional Siglo XXI, IMSS.
González-Martínez
Marina
M
Ruiz-Flores
Luis Guillermo
LG
Blancas-Valencia
Juan Manuel
JM
Morán-Villota
Segundo
S
Dehesa-Violante
Margarita
M
D000328:Adult; D000368:Aged; D002637:Chest Pain / Q000209:etiology* / Q000523:psychology; D003680:Deglutition Disorders / Q000150:complications*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D050782:Esophageal pH Monitoring; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000175:diagnosis; D006356:Heartburn / Q000150:complications*; D006801:Humans; D008297:Male; D008365:Manometry; D001523:Mental Disorders / Q000150:complications* / Q000175:diagnosis; D008875:Middle Aged; D011602:Psychophysiologic Disorders / Q000175:diagnosis*