胃食管反流病相关性胸痛之“食心痛”命名及辨治探微

历代研究中缺乏对胃食管反流病相关性胸痛与胸痹之间的有效区分及深入挖掘,阻碍了两者的精准定位与治疗。胃食管反流病相关性胸痛与“食心痛”高度相似,通过对两者源流、证候、病位、病因和病机内容的探析,认为胃食管反流病相关性胸痛可命名为中医学之“食心痛”。临证从痰阻、热郁、气滞病机角度出发,分别运用枳实薤白桂枝汤、栀子豉汤、橘枳姜汤等具有代表性的胸痹名方治疗胃食管反流病相关性胸痛具有较好疗效,体现了中医异病同治之理。

Origin of and therapeutic approach to cardiac syndrome X:Results of the proton pump inhibitor therapy for angina-like lingering pain trial (PITFALL trial)

AIM: To investigate the frequency of gastroen-terological diseases in the etiology and the efficacy of proton pump inhibitors (PPIs) in the treatment of cardiac syndrome X (CSX) as a subform of non-cardiac chest pain (NCCP). METHODS: We investigated 114 patients with CSX using symptom questionnaires. A subgroup of these patients were investigated regarding upper gastrointestinal disorders (GIs) and treated with PPI. Patients not willing to participate in investigation and treatment served as control group. RESULTS: Thirty-six patients denied any residual symptoms and were not further evaluated. After informed consent in 27 of the remaining 78 patients, we determined the prevalence of disorders of the upper GI tract and quantifi ed the effect of treatment with pantoprazole. We found a high prevalence of gastroenterological pathologies (26/27 patients, 97%)with gastritis, gastroesophageal reflux disease (GERD) and acid reflux as the most common associated disorders. If treated according to the study protocol, these patients showed a significant improvement in the symptom score. Patients treated by primary care physicians, not according to the study protocol had a minor response to treatment (n = 19, -43%), while patients not treated at all (n = 26) had no improvement of symptoms (-0%). CONCLUSION: Disorders of the upper GI tract are a frequent origin of CSX in a German population and can be treated with pantoprazole if given for a longer period.

Prevalence of linked angina and gastroesophageal reflux disease in general practice

AIM： To evaluate the association between gastroesophageal reflux diseases （GERD） and coronary heart diseases. METHODS： One thousand nine hundred and seventy consecutive patients who attended our hospital were enrolled. All of the patients who first attend our hospital were asked to respond to the F-scale questionnaire regardless of their chief complaints. All patients had a careful history taken, and resting echocardiography （ECG） was performed by physicians if the diagnostic necessity arose. Patients with ECG signs of coronary artery ischemia were defined as ST- segment depression based on the Minnesota code. RESULTS： Among 712 patients （36%） with GERD, ECG was performed in 171 （24%）, and ischemic changes were detected in eight （5%）. Four （50%） of these patients with abnormal findings upon ECG had no chest symptoms such as chest pain, chest oppression, or palpitations. These patients （0.6%; 4/712） were thought to have non-GERD heartburn, which may be related to ischemic heart disease. Of 281 patients who underwent ECG and did not have GERD symptoms, 20 （7%） had abnormal findings upon ECG. In patients with GERD symptoms and ECG signs of coronary artery ischemia, the prevalence of linked angina was considered to be 0.4% （8/1970 patients）.CONCLUSION： The present study suggested that ischemic heart disease might be found although a patient was referred to the hospital with a complaint of GERD symptoms. Physicians have to be concerned about missing clinically important coronary artery disease while evaluating patients for GERD symptoms.

Symptoms of Early Cancer Especially Barrett’s Carcinoma

The incidence of the adenocarcinoma of the esophagus (AC) has been rising exponentially in the Western World within the last 30 years. The reasons for this increase are not yet understood. Massive and long lasting gastroesophageal re?ux causes the Barrett’s esophagus which is considered to be a precancerosis. Therefore early diagnosis and appropriate treatment of gastroesophageal re?ux is essential for the prevention of this tumor. This makes heartburn the leading clinical symptom in the patient’s history. In patients with heartburn it is possible to early endoscopically diagnose a Barrett’s esophagus or adenocarcinoma of the esophagus. However only few patients with this increased risk receive an index-endoscopy. In clinical studies a high rate of early carcinomas could be found and could be treated with mucosectomie or ablation. The majority of patients with AC present with symptoms suggestive of progressed disease such as dysphagia or weight loss. The prognosis in patients in late disease stages are with a 5-year survival of only 30% far worse than in patients with early carcinoma (85%). However the early symptoms such as heartburn or regurgitation are unspeci?c and make an e?ective diagnostical strategy di?cult. To optimize screening it would be bene?cial to identify patients with high risk for the development of adenocarcinoma of the esophagus.

Angina rapidly improved with a plant-based diet and returned after resuming a Western diet

Atherosclerosis and its related cardiovascular disease is the most common cause of morbidity and mortality in the Western world. The roots of this disease may lie, in part, in dietary and lifestyle behaviors, indicating that modifica- tion of these behaviors may lead to profound improvements.