How Do I Treat a Sore Throat and Chest Pain?

Esophageal chest pain is chest pain caused by esophageal disease or esophageal dysfunction. Its typical symptoms are heartburn accompanied by paroxysmal pain behind or below the sternum, which is squeezing or burning, which occurs most often 30 to 60 minutes after a meal, and is very similar to "angina pectoris". Stimulating food, exercise, and emotional stress can be induced, and spontaneous attacks can also occur.

Basic Information

English name: chest pain of esophageal origin
Visiting department: Internal medicine
Multiple groups: Men after age 50
Common locations: stomach

Common causes: Esophageal disease or esophageal dysfunction (gastroesophageal reflux disease, high peristaltic contraction of the esophagus body, "nutcracker" esophagus, diffuse esophageal spasm, etc.)
Common symptoms: Chest pain, heartburn, acid reflux, burning in the upper abdomen, difficulty swallowing or pain in swallowing, etc.

Causes of esophageal chest pain

1. Gastroesophageal reflux disease (GERD)

It is the most common cause of esophageal chest pain. It can also be found in esophageal ulcers and other digestive disorders.

2. Esophageal dysmotility

Including high amplitude peristaltic contraction of the esophagus, "nutcracker" esophagus, diffuse esophageal spasm, achalasia, high-pressure lower esophageal sphincter, and some non-specific esophageal motion abnormalities.

Clinical manifestations of esophageal chest pain

Chest pain

The characteristics of esophageal chest pain are very similar to "angina pectoris" and are often mistaken for "angina pectoris". It manifests as cramping cramps behind the sternum or under the xiphoid process, but most patients have no relief after taking nitroglycerin. A small number of patients with cardiogenic chest pain and esophageal chest pain alleviate symptoms after taking nitroglycerin, which is often difficult to distinguish.

2. Esophageal Syndrome

Including heartburn, acid reflux, burning sensation in the abdomen, difficulty swallowing, or pain in swallowing. The severity of the symptoms is related to the primary disease, such as diffuse esophageal spasm. Patients often have pain and nausea, which can be induced by eating irritating food.

3. Extraesophageal syndrome

Esophageal chest pain secondary to gastroesophageal reflux may include cough, asthma, pharyngitis, or dyspnea. Symptoms can be relieved after antireflux treatment. Patients with esophageal hiatal hernias have atypical chest pain and may have vomiting and abdominal pain when incarcerated. Spontaneous esophageal rupture, chest pain is asphyxiating, dying, and may be accompanied by breathing, rapid pulse and shock.

Esophageal chest pain examination

1. Patients with recurrent retrosternal or substernal pain should first check the heart, routine ECG, exercise experiments, myocardial markers, coronary angiography, etc. If no positive findings are found, the presence of esophageal factors should be considered. Esophageal barium radiography is also a routine initial screening test. Suspicious patients can be examined by endoscopy to determine whether the esophagus has esophagitis, tumors, and hiatal hernias.

2. If none of the above tests are positive, you can monitor the pH of the esophagus for 24 hours to determine whether the onset of chest pain is related to esophageal acid reflux. Esophageal manometry can also comprehensively evaluate and analyze the relationship between the onset of chest pain and abnormal esophageal peristalsis.

3. The Bernstein acid perfusion test, such as the acid perfusion test, stimulates the onset of angina pectoris-like chest pain, while saline infusion does not induce chest pain, which is positive for the test, suggesting esophageal chest pain.

Diagnosis of esophageal chest pain

1. Clinical characteristics of esophageal chest pain

(1) It is related to gender and age, male is higher than female, male: female is 2: 1, the peak age of onset is after 50 years old.

(2) Most of the pain occurs or worsens during swallowing, which usually occurs 1 hour after a meal and radiates to the shoulder for 4 to 5 minutes.

(3) Other symptoms of esophageal diseases, such as non-progressive dysphagia, heartburn, acid reflux and nocturnal reflux.

(4) Chest pain accompanied by esophageal morphological changes, in addition to chest pain, have more obvious digestive symptoms; those with chest pain associated with esophageal dyskinesia, in addition to chest pain, some patients lack obvious digestive symptoms.

(5) The symptoms of taking nitroglycerin often cannot be relieved.

2. Diagnostic Procedure

Esophageal chest pain needs to be distinguished from cardiogenic chest pain, pulmonary chest pain, musculoskeletal diseases, and other digestive diseases. For patients with recurrent retrosternal or substernal pain, cardiovascular tests should be performed first to rule out heart disease. Then perform routine esophageal barium angiography and endoscopy to determine whether the esophagus has functional or structural abnormalities, and perform special monitoring of esophageal dynamics if necessary.

Treatment of esophageal chest pain

1. Treatment of gastroesophageal reflux disease

To prevent reflux, reduce gastric acid secretion and promote gastric acid clearance. Medications include:

(1) Inhibition of gastric acid secretion Proton pump inhibitors (omeprazole, lansoprazole, etc.), H2 receptor blockers (cimetidine, ranitidine, and famotidine, etc.).

(2) Gastrointestinal prokinetic drugs Mosapride, Etopril, Domperidone, etc.

2. Treatment of esophageal dyskinesia chest pain

(1) Treatment of cardia achalasia. Calcium antagonists (nifedipine and thiazepine), smooth muscle relaxants (hydrazine, etc.) can relieve symptoms. Severe dysphagia with chest pain can be treated with balloon or metal and plastic dilators, and those who do not respond can be treated with esophageal sphincterotomy.

(2) Treatment of esophageal peristalsis and hypertonic esophageal chest pain. Drug therapy can significantly improve the symptoms of diffuse esophageal spasm, nutcracker esophagus, high-pressure LES, and non-specific esophageal dyskinesia. Commonly used drugs are nitroglycerin (nitrate Glycerin and isosorbide nitrate), anticholinergics (dicyclovirin hydrochloride, etc.), calcium antagonists (nifedipine, thiazepine, etc.), smooth muscle relaxants (hydrazine, etc.). Such patients generally do not require instrument expansion or surgery.

(3) Treatment of irritable esophageal chest pain. Psychological suggestion treatment can be performed to eliminate the patient's mental stress. At the same time, sedative or sleeping drugs such as diazepam, trazodone and docet can be given equal treatment.