Study on the contraction pattern of esophageal body in 27 patients with non-cardiac chest pain / 中华消化杂志

Objective:To analyze the differences in the contraction pattern of esophageal body in patients with different types of non-cardiac chest pain (NCCP).Methods:From January 1, 2019 to December 31, 2020, 46 NCCP patients visited the First Affiliated Hospital of Zhejiang Chinese Medical University were selected. According to the Lyon consensus and Rome Ⅳ dignostic criteria, combined with the results of gastr oscopy and 24 h muitichannel intraluminal impedance combined with pH detection monitoring, 27 patients were finally included. The 27 patients were divided into functional chest pain group (12 cases) and gastroesophageal reflux disease (GERD) group (15 cases). The differences in contraction pattern of esophageal body between the two groups were analyzed according to the results of high-resolution esophageal manometry (the maximal wave amplitude of each contraction segment (S1, S2, S3), average contraction amplitude, contraction transmission time, segment lengths, distal contractile integral (DCI) and the DCI ratio of S2 to S3). Independent sample t test and chi-square test were used for statistical analysis. Results:The segment length and contraction transmission time of S3 in GERD group were shorter than those in functional chest pain group, the DCI of S3 in GERD group was lower than that in functional chest pain group, and the DCI ratio of S2 to S3 was higher than that of functional chest pain group ((5.69±0.55) cm vs. (6.61±0.99) cm, (3.45±0.49) s vs. (4.15±0.90) s, (798.88±354.70) mmHg·s·cm (1 mmHg=0.133 kPa) vs. (1 421.45±802.47) mmHg·s·cm, 0.99±0.44 vs. 0.67±0.17), and the differences were statistically significant ( t=2.682, 2.249, 2.308 and -2.616, all P<0.05). In GERD group, the transmitted segment length of S2 was longer than that of S3 ((7.02±1.40) cm vs. (5.69±0.55) cm), the contraction time of S2 of functional chest pain group was shorter than that of S3 ((3.29±0.80) s vs. (4.15±0.90) s), and the differences were statistically significant ( t=3.413 and -2.269, both P<0.05). Conclusion:High-amplitude contraction of S3 mainly occurs in patients with functional chest pain rather than GERD patients, suggesting that it may have a certain value in differential diagnosis of functional chest pain and GERD.

Anxiety and depression among patients of non-cardiac chest pain and other medically ill patients

Background: The current study compared severity of anxiety and depression patients of NCCP and other medical conditions in male adults.Methods: Sample consisted of consenting male patients from cardiology OPD with symptom of chest pain, whereas control group consisted of patients without symptoms of chest pain, aged between 18 to 60 years. Exclusion criteria for both groups included unstable or life-threatening medical conditions, psychosis, substance use disorders, or any psychiatric illness. Both experimental and control group were evaluated with history, clinical examinations and indicated investigations. The socio demographic data sheet and Hospital Anxiety and Depression Scale (HADS) was applied, patients were asked to read all 14 question and place a tick against the reply representing their feelings, the answers were rated with Likert pattern of scoring. The collected data statistically analyzed.Results: A total of 51 patients of experimental group with mean age of 44.82±7.63years and 76 control with mean 46.30±8.45 years were participated for this study. The mean HADS anxiety score for NCCP was 13.29±3.42 and for the group of other patients it was 11.06±3.54 (t value=-3.517, df=125 and p value=0.001). Whereas the mean HADS depression score for NCCP was 12.58±2.76 and for the group of other patients it was 10.90±2.26 (t value=-3.743, df=125 and p value=0.000).Conclusions: NCCP is associated with significantly higher anxiety and depression in comparison to other medically ill patients.

Role of Mixed Reflux and Hypomotility with Delayed Reflux Clearance in Patients with Non-cardiac Chest Pain

BACKGROUND/AIMS: Gastroesophageal reflux disease (GERD) is the most common cause of non-cardiac chest pain (NCCP). Currently available data reveal a weak relationship between NCCP and dysmotility. Moreover, it is unclear why some refluxes are perceived as heartburn and others as NCCP. We aimed to evaluate the role of the reflux pattern and the esophageal motility in patients with NCCP. METHODS: Forty-eight patients with NCCP (Group 1) and 50 only typical GERD symptoms (Group 2) were included and underwent high-resolution manometry (HRM) and multichannel intraluminal impedance-pH monitoring. RESULTS: Impaired peristalsis was found in 60% of patients with NCCP and in 24% of patients with typical symptoms (P < 0.05). In patients belonging to Group 1, the majority of reflux episodes associated with chest pain were acid and mixed. The proportion of mixed refluxes was higher than that in Group 2. In Group 1, the reflux clearing time at 5, 9, and 15 cm, measured in reflux episodes associated to NCCP was longer than in reflux episodes associated to typical symptoms (mean ± 95% CI: 27.2 ± 5.6, 23.3 ± 4.4, and 14.6 ± 2.3 seconds vs 18.3 ± 3.5, 13.3 ± 2.2, and 11.1 ± 1.8 seconds; P < 0.01). CONCLUSIONS: The presence of gas in the refluxate seems to be associated with NCCP. The impaired motility observed in NCCP patients may play a relevant role in delaying reflux clearing, hence increasing the time of contact between refluxate and esophageal mucosa.

Reducing Irrational Beliefs and Pain Severity in Patients Suffering from Non-Cardiac Chest Pain (NCCP): A Comparison of Relaxation Training and Metaphor Therapy

BACKGROUND: Patients suffering from non-cardiac chest pain (NCCP) can interpret their chest pain wrongly despite having received a correct diagnosis. The objective of this study was to compare the efficacy of the relaxation method with metaphor therapy for reducing irrational beliefs and pain severity in patients with NCCP. METHODS: Using a randomized controlled trial, 33 participants were randomly divided into a relaxation training group (n= 13), a metaphor therapy group (n = 10), and a control group (n = 10), and were studied for 4 weeks. The two tools used in this research were the Brief Pain Inventory (BPI) index for determining the degree of pain and the short version of the Jones Irrational Belief Test. Metaphor therapy and a relaxation technique based on Ost's treatment were used as the interventions. The collected data were analyzed with a multivariate analysis of covariance (MANCOVA), a Chi-square test, and the Bonferroni procedure of post-hoc analysis. RESULTS: The relaxation training method was significantly more effective than both metaphor therapy and the lack of treatment in reducing the patients' beliefs of hopelessness in the face of changes and emotional irresponsibility, as well as the pain severity. Metaphor therapy was not effective on any of these factors. In fact, the results did not support the effectiveness of metaphor therapy. CONCLUSIONS: Regarding the effectiveness of the relaxation method as compared with metaphor therapy and the lack of treatment in the control group, this study suggests that relaxation should be paid greater attention as a method for improving the status of patients. In addition, more studies are needed to determine the effectiveness of metaphor therapy in this area.