老年人食道病变呈心绞痛样胸痛13例分析

13例有心绞痛样胸痛的住院病人入院均诊有冠心病心绞痛,后均经ECG、8例心脏“B”超、核素心肌灌注及24小时动态ECG各2例,确诊冠心病5例,不支持冠心病8例;后均行GI,并同时行胃镜、食管24小时pH测定及压力测定各2例,确诊有胃食管反流疾病(GERD),本组自胸痛症状出现至GERD确诊病程平均29.5个月(0.5～120个月),报告2例典型病例,讨论了误漏诊原因,探讨了老年人食管性胸痛的诊疗程序。

Clinical Analysis of 13 Cases of Agina-like Chest Pain in Elderly Patients

13 cases of angina-like chest pain have been analysed in this study. The patients were over 60 years old and their symptoms had been proved to be caused by benign esophageal diseases. By reviewing the literature, the causes of misdiagnosis and the procedure of differential diagnosis are discussed.All the patients were suspected to have coronary heart disease (CHD) on admission. After ECG was performed in all of them, UCG in 8 and radiocardiography in 2 cases, only 5 of them were definitely diagnosed as CHD. Barium meal was also performed in all cases and reflux esophagitis was detected in 11 cases, hiatal hernia in 5, spastic esophagus in 2 and esophageal diverticulum in 2. 24-hour esophageai pH monitoring and lower esophageal sphincter pressure measurement were performed in 2 cases and showed excesive acid exposure and lower LES pressure. The mean duration between the symptoms presentation and esophageal diseases diagnosis was 29.5 mothes(0.5 - 120 months), 8 of them were over 2 years. 2 typical cases are reported in detail.