The Korean Journal of Medicine

  • 제80권6호
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  • Pages.649-655
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  • 2011
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  • 1738-9364(pISSN)
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  • 2289-0769(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
권호 표지

한국의 비심인성 흉통의 진단 및 치료의 고유한 특징

Distinct Characteristics of Noncardiac Chest Pain in Korea

  • 김정환 (건국대학교 의학전문대학원 내과학교실, 건국대학교병원 소화기병센터)
  • Kim, Jeong-Hwan (Department of Internal Medicine, Digestive Disease Center, Konkuk University School of Medicine, Konkuk University Medical Center)
  • 발행 : 2011.06.01
⟨ 이전 논문 다음 논문 ⟩

초록

Gastroesophageal reflux disease (GERD) is the most common cause of noncardiac chest pain (NCCP) and was reported to cause 41% of cases of NCCP in a recent study of Korea. Typical reflux symptoms were reported to be frequent in Korean patients suffering from NCCP. Therefore, a careful history of the symptoms is relatively indicative of GERD diagnosis in Korea. In Korea, contrasting Western countries, patients with NCCP but present no alarm features should undergo endoscopy to exclude gastric cancer or peptic ulcer. In a primary care setting, PPI test is sufficient for the presumptive diagnosis of GERD. Specifically in Korea, the optimal duration of PPI test may be at least 2 weeks because of less frequent or atypical GERD symptoms. In patients diagnosed with GERD-related NCCP, the initial long term therapy (more than 2 months) followed to the maintenance therapy is required to alleviate symptoms. Esophageal dysmotility is relatively uncommon, and pain modulators seem to offer significant improvement in chest pain control in non GERD-related NCCP. Unfortunately, the majority of traditionally available tricyclics or heterocyclics have many undesirable effects. Therefore, newer drugs with fewer side effects may be needed, such as the serotonin-norepinephrine reuptake inhibitors.

키워드

참고문헌

  1. Faybush EM, Fass R. Gastroesophageal reflux disease in noncardiac chest pain. Gastroenterol Clin North Am 2004;33:41-54. https://doi.org/10.1016/S0889-8553(03)00131-6
  2. Eslick GD, Fass R. Noncardiac chest pain: evaluation and treatment. Gastroenterol Clin North Am 2003;32:531-552. https://doi.org/10.1016/S0889-8553(03)00029-3
  3. Eslick GD, Jones MP, Talley NJ. Non-cardiac chest pain: prevalence, risk factors, impact and consulting--a population-based study. Aliment Pharmacol Ther 2003;17:1115-1124. https://doi.org/10.1046/j.1365-2036.2003.01557.x
  4. Locke GR 3rd, Talley NJ, Fett SL, Zinsmeister AR, Melton LJ 3rd. Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Olmsted County, Minnesota. Gastroenterology 1997;112:1448-1456. https://doi.org/10.1016/S0016-5085(97)70025-8
  5. Chambers J, Bass C. Chest pain with normal coronary anatomy: a review of natural history and possible etiologic factors. Prog Cardiovasc Dis 1990;33:161-184. https://doi.org/10.1016/0033-0620(90)90007-O
  6. Eslick GD, Talley NJ. Non-cardiac chest pain: predictors of health care seeking, the types of health care professional consulted, work absenteeism and interruption of daily activities. Aliment Pharmacol Ther 2004;20:909-915. https://doi.org/10.1111/j.1365-2036.2004.02175.x
  7. Nevens F, Janssens J, Piessens J, Ghillebert G, De Geest H, Vantrappen G. Prospective study on prevalence of esophageal chest pain in patients referred on an elective basis to a cardiac unit for suspected myocardial ischemia. Dig Dis Sci 1991;36:229-235. https://doi.org/10.1007/BF01300762
  8. Graves EJ, Gillum BS. Detailed diagnoses and procedures, National Hospital Discharge Survey, 1995. Vital Health Stat 13 1997;130:1-146.
  9. Achem SR, DeVault KR. Recent developments in chest pain of undetermined origin. Curr Gastroenterol Rep 2000;2:201-209. https://doi.org/10.1007/s11894-000-0062-4
  10. Van Handel D, Fass R. The pathophysiology of non-cardiac chest pain. J Gastroenterol Hepatol 2005;20 Suppl:S6-13.
  11. Pandak WM, Arezo S, Everett S, et al. Short course of omeprazole: a better first diagnostic approach to noncardiac chest pain than endoscopy, manometry, or 24-hour esophageal pH monitoring. J Clin Gastroenterol 2002;35:307-314. https://doi.org/10.1097/00004836-200210000-00006
  12. Wong WM, Lai KC, Lau CP, et al. Upper gastrointestinal evaluation of Chinese patients with non-cardiac chest pain. Aliment Pharmacol Ther 2002;16:465-471. https://doi.org/10.1046/j.1365-2036.2002.01217.x
  13. Kim JH, Rhee PL, Park EH, Son HJ, Kim JJ, Rhee JC. Clinical usefulness of subgrouping of patients with non-cardiac chest pain according to characteristic symptoms in Korea. J Gastroenterol Hepatol 2007;22:320-325. https://doi.org/10.1111/j.1440-1746.2006.04264.x
  14. Fass R, Dickman R. Non-cardiac chest pain: an update. Neurogastroenterol Motil 2006;18:408-417. https://doi.org/10.1111/j.1365-2982.2006.00787.x
  15. Richter JE. Chest pain and gastroesophageal reflux disease. J Clin Gastroenterol 2000;30:S39-S41.
  16. Fass R, Fennerty MB, Ofman JJ, et al. The clinical and economic value of a short course of omeprazole in patients with noncardiac chest pain. Gastroenterology 1998;115:42-49. https://doi.org/10.1016/S0016-5085(98)70363-4
  17. Bautista J, Fullerton H, Briseno M, et al. The effect of an empirical trial of high-dose lansoprazole on symptom response of patients with non-cardiac chest pain-a randomized, double-blind, placebocontrolled, crossover trial. Aliment Pharmacol Ther 2004;19: 1123-1130. https://doi.org/10.1111/j.1365-2036.2004.01941.x
  18. Frobert O, Funch-Jensen P, Jacobsen NO, et al. Upper endoscopy in patients with angina and normal coronary angiograms. Endoscopy 1995;27:365-370. https://doi.org/10.1055/s-2007-1005715
  19. Dickman R, Mattek N, Holub J, Peters D, Fass R. Prevalence of upper gastrointestinal tract findings in patients with noncardiac chest pain versus those with gastroesophageal reflux disease (GERD)-related symptoms: results from a national endoscopic database. Am J Gastroenterol 2007;102:1173-1179 https://doi.org/10.1111/j.1572-0241.2007.01117.x
  20. Kapoor N, Bassi A, Sturgess R, Bodger K. Predictive value of alarm features in a rapid access upper gastrointestinal cancer service. Gut 2005;54:40-45. https://doi.org/10.1136/gut.2004.039438
  21. Cremonini F, Wise J, Moayyedi P, Talley NJ. Diagnostic and therapeutic use of proton pump inhibitors in non-cardiac chest pain: a metaanalysis. Am J Gastroenterol 2005;100:1226-1232. https://doi.org/10.1111/j.1572-0241.2005.41657.x
  22. Wang WH, Huang JQ, Zheng GF, et al. Is proton pump inhibitor testing an effective approach to diagnose gastroesophageal reflux disease in patients with noncardiac chest pain?: a meta-analysis. Arch Intern Med 2005;165:1222-1228. https://doi.org/10.1001/archinte.165.11.1222
  23. Numans ME, Lau J, de Wit NJ, Bonis PA. Short-term treatment with proton-pump inhibitors as a test for gastroesophageal reflux disease: a meta-analysis of diagnostic test characteristics. Ann Intern Med 2004;140:518-527. https://doi.org/10.7326/0003-4819-140-7-200404060-00011
  24. Cherian P, Smith LF, Bardhan KD, et al. Esophageal tests in the evaluation of non-cardiac chest pain. Dis Esophagus 1995;8: 129-133. https://doi.org/10.1093/dote/8.2.129
  25. Vaezi MF, Hicks DM, Abelson TI, Richter JE. Laryngeal signs and symptoms and gastroesophageal reflux disease (GERD): a critical assessment of cause and effect association. Clin Gastroenterol Hepatol 2003;1:333-344. https://doi.org/10.1053/S1542-3565(03)00177-0
  26. Garcia-Compean D, Gonzalez MV, Galindo G, et al. Prevalence of gastroesophageal reflux disease in patients with extraesophageal symptoms referred from otolaryngology, allergy, and cardiology practices: A prospective study. Dig Dis Sci 2000;18:178-182. https://doi.org/10.1159/000051392
  27. Hsia PC, Maher KA, Lewis JH, et al. Utility of upper endoscopy in the evaluation of noncardiac chest pain. Gastrointest Endosc 1991;37:22-26. https://doi.org/10.1016/S0016-5107(91)70615-9
  28. Bruley des Varannes S, Levy P, Lartigue S, Dellatolas F, Lemaire M, Galmiche JP. Comparison of lansoprazole with omeprazole on 24-hour intragastric pH, acid secretion and serum gastrin in healthy volunteers. Aliment Pharmacol Ther 1994;8:309-314.
  29. Dickman R, Emmons S, Cui H, et al. The effect of a therapeutic trial of high-dose rabeprazole on symptom response of patients with non-cardiac chest pain: a randomized, double-blind, placebocontrolled, crossover trial. Aliment Pharmacol Ther 2005;22: 547-555. https://doi.org/10.1111/j.1365-2036.2005.02620.x
  30. Jung HY, Jung KW, Huh KC, et al. GERD Club of The Korean Society of Neurogastroenterology and Motility. Diagnostic significance of one-week esomeprazole treatment in gastroesophageal reflux disease. Korean J Neurogastroenterol Motil. 2008;14:88-95.
  31. Battaglia E, Bassotti G, Buonafede G, et al. Noncardiac chest pain of esophageal origin in patients with and without coronary artery disease. Hepatogastroenterology 2005;52:792-795.
  32. Bautista J, Fullerton H, Briseno M, et al. The effect of an empirical trial of high-dose lansoprazole on symptom response of patients with non-cardiac chest pain-a randomized, double-blind, placebocontrolled, crossover trial. Aliment Pharmacol Ther 2004;19: 1123-1130. https://doi.org/10.1111/j.1365-2036.2004.01941.x
  33. Wong WM, Lai KC, Lam KF, et al. Prevalence, clinical spectrum and health care utilization of gastro-oesophageal reflux disease in a Chinese population: a population-based study. Aliment Pharmacol Ther 2003;18:595-604. https://doi.org/10.1046/j.1365-2036.2003.01737.x
  34. Kim JH, Sinn DH, Son HJ, Kim JJ, Rhee JC, Rhee PL. Comparison of one-week and two-week empirical trial with a high-dose rabeprazole in non-cardiac chest pain patients. J Gastroenterol Hepatol 2009;24:1504-1509. https://doi.org/10.1111/j.1440-1746.2009.05859.x
  35. Kahrilas PJ, Clouse RE, Hogan WJ. American Gastroenterological Association technical review on the clinical use of esophageal manometry. Gastroenterology 1994;107:1865-1884.
  36. Dekel R, Martinez-Hawthorne SD, Guillen RJ, Fass R. Evaluation of symptom index in identifying gastroesophageal reflux diseaserelated noncardiac chest pain. J Clin Gastroenterol 2004;38:24-29. https://doi.org/10.1097/00004836-200401000-00007
  37. Beedassy A, Katz PO, Gruber A, Peghini PL, Castell DO. Prior sensitization of esophageal mucosa by acid reflux predisposes to reflux-induced chest pain. J Clin Gastroenterol 2000;31:121-124. https://doi.org/10.1097/00004836-200009000-00006
  38. Kusano M, Ino K, Yamada T, et al. Interobserver and intraobserver variation in endoscopic assessment of GERD using the "Los Angeles" classification. Gastrointest Endosc 1999;49:700-704. https://doi.org/10.1016/S0016-5107(99)70285-3
  39. Tutuian R, Castell DO. Review article: complete gastrooesophageal reflux monitoring - combined pH and impedance. Aliment Pharmacol Ther 2006;24 Suppl 2:27-37. https://doi.org/10.1111/j.1365-2036.2006.03039.x
  40. Tutuian R, Vela MF, Shay SS, Castell DO. Multichannel intraluminal impedance in esophageal function testing and gastroesophageal reflux monitoring. J Clin Gastroenterol 2003;37: 206-215. https://doi.org/10.1097/00004836-200309000-00004
  41. Kim BJ, Choi SC, Kim JJ, Rhee JC, Rhee PL. Pathological bolus exposure plays a significant role in eliciting non-cardiac chest pain. J Gastroenterol Hepatol 2010;25:1855-1860. https://doi.org/10.1111/j.1440-1746.2010.06415.x
  42. Caro J, Salas M, Ward A. Healing and relapse rates in gastroesophageal reflux disease treated with the newer proton-pump inhibitors lansoprazole, rabeprazole and pantoprzole compared with omeprazole, ranitidine, and placebo: evidence from randomized clinical trials. Clin Ther 2001;23:998-1017. https://doi.org/10.1016/S0149-2918(01)80087-4
  43. Dekel R, Morse C, Fass R. The role of proton pump inhibitors in gastro-oesophageal reflux disease. Drugs 2004;64:277-295. https://doi.org/10.2165/00003495-200464030-00004
  44. Vigneri S, Termini R, Leandro G, et al. A Comparison of five maintenance therapies for reflux esophagitis. N Engl J Med 1995; 333:1106-1110. https://doi.org/10.1056/NEJM199510263331703
  45. Sarkar S, Aziz Q, Woolf CJ, Hobson AR, Thompson DG. Contribution of central sensitisation to the development of non-cardiac chest pain. Lancet 2000;356:1154-1159. https://doi.org/10.1016/S0140-6736(00)02758-6
  46. Rao SS, Mudipalli RS, Remes-Troche JM, Utech CL, Zimmerman B. Theophylline improves esophageal chest pain--a randomized, placebo-controlled study. Am J Gastroenterol 2007;102:930-938. https://doi.org/10.1111/j.1572-0241.2007.01112.x
  47. Lee H, Kim JH, Min BH, et al. Efficacy of venlafaxine for symptomatic relief in young adult patients with functional chest pain: a randomized, double-blind, placebo-controlled, crossover trial. Am J Gastroenterol 2010;105:1504-1512. https://doi.org/10.1038/ajg.2010.82