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Некардиальные боли в грудной клетке: взгляд гастроэнтеролога и терапевта
Некардиальные боли в грудной клетке: взгляд гастроэнтеролога и терапевта
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Аннотация
В статье представлен критический обзор по патогенетическим механизмам возникновения некардиальных болей в грудной клетке (НКБГ), рассматривается роль кислотозависимых и моторно-тонических поражений пищевода, висцеральной гиперчувствительности, психических нарушений и других коморбидных состояний. Предлагаются алгоритм диагностики и лечения НКБГ, связанных с патологией пищевода, и схема дифференциальной диагностики ИБС и гастроэзофагеальной рефлюксной болезни по клиническим признакам. Представлены результаты собственного исследования, посвященного изучению роли препаратов из группы ингибиторов протонной помпы при ведении больных с НКБГ.
Ключевые слова: некардиальные боли в грудной клетке, гастроэзофагеальная рефлюксная болезнь, нарушения моторики пищевода, ахалазия пищевода, пищевод щелкунчика, диффузный эзофагоспазм, неспецифическое расстройство моторики пищевода, висцеральная гиперчувствительность, алгоритм диагностики и лечения некардиальных болей в грудной клетке, тест с ингибиторами протонной помпы.
Key words: non-cardiac chest pain, gastroesophageal reflux disease, esophageal dysmotility, achalasia of the esophagus, nutcracker esophagus, diffuse esophagism, non-specific esophageal motility disorder, visceral hypersensitivity, algorithm for diagnostic and treatment of non-cardiac chest pain, test with proton pump inhibitors.
Ключевые слова: некардиальные боли в грудной клетке, гастроэзофагеальная рефлюксная болезнь, нарушения моторики пищевода, ахалазия пищевода, пищевод щелкунчика, диффузный эзофагоспазм, неспецифическое расстройство моторики пищевода, висцеральная гиперчувствительность, алгоритм диагностики и лечения некардиальных болей в грудной клетке, тест с ингибиторами протонной помпы.
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Key words: non-cardiac chest pain, gastroesophageal reflux disease, esophageal dysmotility, achalasia of the esophagus, nutcracker esophagus, diffuse esophagism, non-specific esophageal motility disorder, visceral hypersensitivity, algorithm for diagnostic and treatment of non-cardiac chest pain, test with proton pump inhibitors.
Полный текст
Список литературы
1. Fass R, Eslick GD. Noncardiac chest pain: a growing medical problem. San Diego: Plural Publishing Inc., 2007.
2. Locke GR 3rd, Talley NJ, Fett SL et al. Prevalence and clinical spectrum of gastro-oesophageal reflux: a population-based study in Olmsted County. Minnesota Gastroenterol 1997; 112: 1448–56.
3. Eslick GD, Coulshed DS, Talley NJ. Diagnosis and treatment of noncardiac chest pain. Nat Clin Pract Gastroenterol Hepatol 2005; 2: 463–72.
4. Fass R, Fennerty MB, Ofman JJ et al. The clinical and economic value of a short course of omeprazole patients with non-cardiac chest pain. Gastroenterol 1998; 115 (1): 42–9.
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6. Eslick GD. Noncardiac chest pain: epidemiology, natural history, health care seeking, and quality of life Gastroenterol. Clin North Am 2004; 33 (l): 1–23.
7. Hewson EG, Sinclair JW, Dalton CB, Richter JE. Twenty-four-hour esophageal pH monitoring: the most useful test for evaluating noncardiac chest pain. Am J Med 1991; 90 (5): 576–83.
8. Chauhan A, Petch MC, Schofield PM. Cardio-esophageal reflex in humans as a mechanism for «linked angina». Eur Heart J 1996; 17: 407–13.
9. Dekel R, Pearson T, Wendel C et al. Assessment of oesophageal motor function in patients with dysphagia or chest pain – the Clinical Outcomes Research Initiative experience. Aliment Pharmacol Ther 2003; 18 (11–12): 1083–9.
10. Katz PO, Dalton CB, Richter JE et al. Esophageal testing of patients with noncardiac chest pain or dysphagia. Results of three years’ experience in 1161 patients. Ann Intern Med 1987; 106 (4): 593–7.
11. DiMarino AJ Jr, Allen ML, Lynn RB, Zamani S. Clinical value of esophageal motility testing. Dig Dis 1998; 16 (4): 198–204.
12. Achem SR, Kolts BE, Wears R et al. Chest pain associated with nutcracker esophagus: a preliminary study of the role of gastroesophageal reflux. Am J Gastroenterol 1993; 88 (2): 187–92.
13. Pehlivanov N, Liu J, Mittal RK. Sustained esophageal contraction: a motor correlate of heart-burn symptoms. Am J Physiol Gastrointest Liver Physiol 2001; 281 (3): G743–51.
14. Aziz Q. Acid sensors in the gut: a taste of things to come Eur J Gastroenterol Hepatol 2001; 13 (8): 885–8.
15. Hollerbach S, Bulat R, May A et al. Abnormal cerebral processing oesophageal stimuli in patients with noncardiac chest pain (NCCP) Neurogastroenterol Motil 2000; 12 (6): 555–65.
16. Fang J, Bjorkman D. A critical approach to noncardiac chest pain: pathophysiology, diagnosis, and treatment. Am J Gastroenterol 2001; 96 (4): 958–68.
17. Paterson WG. Canadian Association of Gastroenterology Practice Guidelines: management of noncardiac chest pain. Can J Gastroenterol 1998; 12 (6): 401–7.
18. Pandolfino JE, Richter JE, Ourts T et al. Ambulatory esophageal pH monitoring using a wireless system. Am J Gastroenterol 2003; 98 (4): 740–9.
19. Swenson JM, Fischer DR, Miller SA et al. Are chest pain radiographs and electocardiograms still valuable in evaluating new pediatric patients with heart murmurs or chest pain? Pediatrics 1997; 991: 1–3.
20. Song CW, Lee SJ, Jeem YT et al. Inconsistent association of esophageal symptoms, psychometric abnormalities and dysmotility. Am J Gastroenterol 2001; 96 (8): 2312–6.
2. Locke GR 3rd, Talley NJ, Fett SL et al. Prevalence and clinical spectrum of gastro-oesophageal reflux: a population-based study in Olmsted County. Minnesota Gastroenterol 1997; 112: 1448–56.
3. Eslick GD, Coulshed DS, Talley NJ. Diagnosis and treatment of noncardiac chest pain. Nat Clin Pract Gastroenterol Hepatol 2005; 2: 463–72.
4. Fass R, Fennerty MB, Ofman JJ et al. The clinical and economic value of a short course of omeprazole patients with non-cardiac chest pain. Gastroenterol 1998; 115 (1): 42–9.
5. Katz PO, Castell DO. Approach to the patient with unexplained chest pain. Am J Gastroenterol 2000; 95 (Suppl. 8): S4–8.
6. Eslick GD. Noncardiac chest pain: epidemiology, natural history, health care seeking, and quality of life Gastroenterol. Clin North Am 2004; 33 (l): 1–23.
7. Hewson EG, Sinclair JW, Dalton CB, Richter JE. Twenty-four-hour esophageal pH monitoring: the most useful test for evaluating noncardiac chest pain. Am J Med 1991; 90 (5): 576–83.
8. Chauhan A, Petch MC, Schofield PM. Cardio-esophageal reflex in humans as a mechanism for «linked angina». Eur Heart J 1996; 17: 407–13.
9. Dekel R, Pearson T, Wendel C et al. Assessment of oesophageal motor function in patients with dysphagia or chest pain – the Clinical Outcomes Research Initiative experience. Aliment Pharmacol Ther 2003; 18 (11–12): 1083–9.
10. Katz PO, Dalton CB, Richter JE et al. Esophageal testing of patients with noncardiac chest pain or dysphagia. Results of three years’ experience in 1161 patients. Ann Intern Med 1987; 106 (4): 593–7.
11. DiMarino AJ Jr, Allen ML, Lynn RB, Zamani S. Clinical value of esophageal motility testing. Dig Dis 1998; 16 (4): 198–204.
12. Achem SR, Kolts BE, Wears R et al. Chest pain associated with nutcracker esophagus: a preliminary study of the role of gastroesophageal reflux. Am J Gastroenterol 1993; 88 (2): 187–92.
13. Pehlivanov N, Liu J, Mittal RK. Sustained esophageal contraction: a motor correlate of heart-burn symptoms. Am J Physiol Gastrointest Liver Physiol 2001; 281 (3): G743–51.
14. Aziz Q. Acid sensors in the gut: a taste of things to come Eur J Gastroenterol Hepatol 2001; 13 (8): 885–8.
15. Hollerbach S, Bulat R, May A et al. Abnormal cerebral processing oesophageal stimuli in patients with noncardiac chest pain (NCCP) Neurogastroenterol Motil 2000; 12 (6): 555–65.
16. Fang J, Bjorkman D. A critical approach to noncardiac chest pain: pathophysiology, diagnosis, and treatment. Am J Gastroenterol 2001; 96 (4): 958–68.
17. Paterson WG. Canadian Association of Gastroenterology Practice Guidelines: management of noncardiac chest pain. Can J Gastroenterol 1998; 12 (6): 401–7.
18. Pandolfino JE, Richter JE, Ourts T et al. Ambulatory esophageal pH monitoring using a wireless system. Am J Gastroenterol 2003; 98 (4): 740–9.
19. Swenson JM, Fischer DR, Miller SA et al. Are chest pain radiographs and electocardiograms still valuable in evaluating new pediatric patients with heart murmurs or chest pain? Pediatrics 1997; 991: 1–3.
20. Song CW, Lee SJ, Jeem YT et al. Inconsistent association of esophageal symptoms, psychometric abnormalities and dysmotility. Am J Gastroenterol 2001; 96 (8): 2312–6.
2. Locke GR 3rd, Talley NJ, Fett SL et al. Prevalence and clinical spectrum of gastro-oesophageal reflux: a population-based study in Olmsted County. Minnesota Gastroenterol 1997; 112: 1448–56.
3. Eslick GD, Coulshed DS, Talley NJ. Diagnosis and treatment of noncardiac chest pain. Nat Clin Pract Gastroenterol Hepatol 2005; 2: 463–72.
4. Fass R, Fennerty MB, Ofman JJ et al. The clinical and economic value of a short course of omeprazole patients with non-cardiac chest pain. Gastroenterol 1998; 115 (1): 42–9.
5. Katz PO, Castell DO. Approach to the patient with unexplained chest pain. Am J Gastroenterol 2000; 95 (Suppl. 8): S4–8.
6. Eslick GD. Noncardiac chest pain: epidemiology, natural history, health care seeking, and quality of life Gastroenterol. Clin North Am 2004; 33 (l): 1–23.
7. Hewson EG, Sinclair JW, Dalton CB, Richter JE. Twenty-four-hour esophageal pH monitoring: the most useful test for evaluating noncardiac chest pain. Am J Med 1991; 90 (5): 576–83.
8. Chauhan A, Petch MC, Schofield PM. Cardio-esophageal reflex in humans as a mechanism for «linked angina». Eur Heart J 1996; 17: 407–13.
9. Dekel R, Pearson T, Wendel C et al. Assessment of oesophageal motor function in patients with dysphagia or chest pain – the Clinical Outcomes Research Initiative experience. Aliment Pharmacol Ther 2003; 18 (11–12): 1083–9.
10. Katz PO, Dalton CB, Richter JE et al. Esophageal testing of patients with noncardiac chest pain or dysphagia. Results of three years’ experience in 1161 patients. Ann Intern Med 1987; 106 (4): 593–7.
11. DiMarino AJ Jr, Allen ML, Lynn RB, Zamani S. Clinical value of esophageal motility testing. Dig Dis 1998; 16 (4): 198–204.
12. Achem SR, Kolts BE, Wears R et al. Chest pain associated with nutcracker esophagus: a preliminary study of the role of gastroesophageal reflux. Am J Gastroenterol 1993; 88 (2): 187–92.
13. Pehlivanov N, Liu J, Mittal RK. Sustained esophageal contraction: a motor correlate of heart-burn symptoms. Am J Physiol Gastrointest Liver Physiol 2001; 281 (3): G743–51.
14. Aziz Q. Acid sensors in the gut: a taste of things to come Eur J Gastroenterol Hepatol 2001; 13 (8): 885–8.
15. Hollerbach S, Bulat R, May A et al. Abnormal cerebral processing oesophageal stimuli in patients with noncardiac chest pain (NCCP) Neurogastroenterol Motil 2000; 12 (6): 555–65.
16. Fang J, Bjorkman D. A critical approach to noncardiac chest pain: pathophysiology, diagnosis, and treatment. Am J Gastroenterol 2001; 96 (4): 958–68.
17. Paterson WG. Canadian Association of Gastroenterology Practice Guidelines: management of noncardiac chest pain. Can J Gastroenterol 1998; 12 (6): 401–7.
18. Pandolfino JE, Richter JE, Ourts T et al. Ambulatory esophageal pH monitoring using a wireless system. Am J Gastroenterol 2003; 98 (4): 740–9.
19. Swenson JM, Fischer DR, Miller SA et al. Are chest pain radiographs and electocardiograms still valuable in evaluating new pediatric patients with heart murmurs or chest pain? Pediatrics 1997; 991: 1–3.
20. Song CW, Lee SJ, Jeem YT et al. Inconsistent association of esophageal symptoms, psychometric abnormalities and dysmotility. Am J Gastroenterol 2001; 96 (8): 2312–6.
________________________________________________
2. Locke GR 3rd, Talley NJ, Fett SL et al. Prevalence and clinical spectrum of gastro-oesophageal reflux: a population-based study in Olmsted County. Minnesota Gastroenterol 1997; 112: 1448–56.
3. Eslick GD, Coulshed DS, Talley NJ. Diagnosis and treatment of noncardiac chest pain. Nat Clin Pract Gastroenterol Hepatol 2005; 2: 463–72.
4. Fass R, Fennerty MB, Ofman JJ et al. The clinical and economic value of a short course of omeprazole patients with non-cardiac chest pain. Gastroenterol 1998; 115 (1): 42–9.
5. Katz PO, Castell DO. Approach to the patient with unexplained chest pain. Am J Gastroenterol 2000; 95 (Suppl. 8): S4–8.
6. Eslick GD. Noncardiac chest pain: epidemiology, natural history, health care seeking, and quality of life Gastroenterol. Clin North Am 2004; 33 (l): 1–23.
7. Hewson EG, Sinclair JW, Dalton CB, Richter JE. Twenty-four-hour esophageal pH monitoring: the most useful test for evaluating noncardiac chest pain. Am J Med 1991; 90 (5): 576–83.
8. Chauhan A, Petch MC, Schofield PM. Cardio-esophageal reflex in humans as a mechanism for «linked angina». Eur Heart J 1996; 17: 407–13.
9. Dekel R, Pearson T, Wendel C et al. Assessment of oesophageal motor function in patients with dysphagia or chest pain – the Clinical Outcomes Research Initiative experience. Aliment Pharmacol Ther 2003; 18 (11–12): 1083–9.
10. Katz PO, Dalton CB, Richter JE et al. Esophageal testing of patients with noncardiac chest pain or dysphagia. Results of three years’ experience in 1161 patients. Ann Intern Med 1987; 106 (4): 593–7.
11. DiMarino AJ Jr, Allen ML, Lynn RB, Zamani S. Clinical value of esophageal motility testing. Dig Dis 1998; 16 (4): 198–204.
12. Achem SR, Kolts BE, Wears R et al. Chest pain associated with nutcracker esophagus: a preliminary study of the role of gastroesophageal reflux. Am J Gastroenterol 1993; 88 (2): 187–92.
13. Pehlivanov N, Liu J, Mittal RK. Sustained esophageal contraction: a motor correlate of heart-burn symptoms. Am J Physiol Gastrointest Liver Physiol 2001; 281 (3): G743–51.
14. Aziz Q. Acid sensors in the gut: a taste of things to come Eur J Gastroenterol Hepatol 2001; 13 (8): 885–8.
15. Hollerbach S, Bulat R, May A et al. Abnormal cerebral processing oesophageal stimuli in patients with noncardiac chest pain (NCCP) Neurogastroenterol Motil 2000; 12 (6): 555–65.
16. Fang J, Bjorkman D. A critical approach to noncardiac chest pain: pathophysiology, diagnosis, and treatment. Am J Gastroenterol 2001; 96 (4): 958–68.
17. Paterson WG. Canadian Association of Gastroenterology Practice Guidelines: management of noncardiac chest pain. Can J Gastroenterol 1998; 12 (6): 401–7.
18. Pandolfino JE, Richter JE, Ourts T et al. Ambulatory esophageal pH monitoring using a wireless system. Am J Gastroenterol 2003; 98 (4): 740–9.
19. Swenson JM, Fischer DR, Miller SA et al. Are chest pain radiographs and electocardiograms still valuable in evaluating new pediatric patients with heart murmurs or chest pain? Pediatrics 1997; 991: 1–3.
20. Song CW, Lee SJ, Jeem YT et al. Inconsistent association of esophageal symptoms, psychometric abnormalities and dysmotility. Am J Gastroenterol 2001; 96 (8): 2312–6.
Авторы
И.В.Маев, Г.Л.Юренев
ГОУ ВПО Московский государственный медико-стоматологический университет Минздравсоцразвития РФ
State Educational Institution of Higher Professional Educational Institution «Moscow State Medical and Dental University»
ГОУ ВПО Московский государственный медико-стоматологический университет Минздравсоцразвития РФ
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State Educational Institution of Higher Professional Educational Institution «Moscow State Medical and Dental University»
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