The Mexican consensus on non-cardiac chest pain. / Consenso mexicano sobre dolor torácico no cardiaco.

INTRODUCTION: Non-cardiac chest pain is defined as a clinical syndrome characterized by retrosternal pain similar to that of angina pectoris, but of non-cardiac origin and produced by esophageal, musculoskeletal, pulmonary, or psychiatric diseases. AIM: To present a consensus review based on evidence regarding the definition, epidemiology, pathophysiology, and diagnosis of non-cardiac chest pain, as well as the therapeutic options for those patients. METHODS: Three general coordinators carried out a literature review of all articles published in English and Spanish on the theme and formulated 38 initial statements, dividing them into 3 main categories: (i)definitions, epidemiology, and pathophysiology; (ii)diagnosis, and (iii)treatment. The statements underwent 3rounds of voting, utilizing the Delphi system. The final statements were those that reached >75% agreement, and they were rated utilizing the GRADE system. RESULTS AND CONCLUSIONS: The final consensus included 29 statements. All patients presenting with chest pain should initially be evaluated by a cardiologist. The most common cause of non-cardiac chest pain is gastroesophageal reflux disease. If there are no alarm symptoms, the initial approach should be a therapeutic trial with a proton pump inhibitor for 2-4weeks. If dysphagia or alarm symptoms are present, endoscopy is recommended. High-resolution manometry is the best method for ruling out spastic motor disorders and achalasia and pH monitoring aids in demonstrating abnormal esophageal acid exposure. Treatment should be directed at the pathophysiologic mechanism. It can include proton pump inhibitors, neuromodulators and/or smooth muscle relaxants, psychologic intervention and/or cognitive therapy, and occasionally surgery or endoscopic therapy.

Capsaicin induction of esophageal symptoms in different phenotypes of gastroesophageal reflux disease.

BACKGROUND: Type 1 vanilloid receptors (TRPV1) have been described on esophageal afferent sensitive neurons. Stimulation of TRPV1 receptors with capsaicin may induce heartburn. Capsaicin is the pungent component of chili and the most extensively studied TRPV1 agonist. OBJECTIVES: To investigate the effect of esophageal stimulation with intraesophageal capsaicin administration on induction of esophageal symptoms and on esophageal chemo-sensitization to acid in different gastroesophageal reflux disease (GERD) phenotypes. METHODS: Healthy volunteers and patients with GERD (non-erosive [NERD], erosive GERD [EE] and Barrett's esophagus [BE]) were prospectively studied. All subjects were randomized to receive either intraesophageal perfusion capsaicin or saline 0.9%. Thirty minutes after saline or capsaicin infusion an acid perfusion test of HCl was performed. A week later, a crossover phase with capsaicin versus saline was performed. Five symptoms were evaluated every 5 min during the first 30 minutes after capsaicin, saline, and acid perfusion: chest burning, chest pain, heartburn, epigastric burning, and epigastric pain. RESULTS: 17 healthy subjects and 31 GERD patients (10 NERD, 11 EE, and 10 BE) were included. Twenty- eight (90%) of GERD and 6 (35%) of healthy subjects had esophageal symptoms after capsaicin perfusion. Mean for the 5 evaluated symptoms induced by capsaicin was significantly higher in the GERD group compared to the control group. The highest symptom severity was in the erosive subgroup. Capsaicin decreased the 5 symptoms induced by acid perfusion in both healthy volunteers and GERD patients. Total score of esophageal symptom severity (produced by acid perfusion) was significantly reduced by capsaicin infusion in the BE group. CONCLUSIONS: Capsaicin induces esophageal and gastric symptoms in healthy volunteers and GERD patients. Capsaicin reduces esophageal chemosensitivity to acid, especially in patients with BE.

[Crohn's disease of the digestive tract proximal. A rare presentation of an uncommon disease in Mexico]. / Enfermedad de Crohn del tubo digestivo proximal. Una presentación rara de una enfermedadpoco común en México.

UNLABELLED: Although Crohn Disease (CD) can affect any part of the digestive tract its presentation in the upper digestive tract (UDT) is very uncommon. Recently we have seen some patients with CD in UDT. Because our Institute is a third level reference hospital in Mexico, we decided to review all patients with CD looking for those with UDT in order to know their clinical. MATERIAL AND METHODS: [corrected] Clinical records of all patients with histological diagnosis of CD were reviewed. Clinical and biochemical analysis was done in each case. Location of CD was established by endoscopy or radiology methods. Statistical differences were evaluated by Student t test,Fisher exact test and X2 test. RESULTS: The diagnosis of CD was established in 72 patients during the period of study (13 years). Sixty of them had distal CD while lesions in the upper digestive tract were detected in 12 (17%). Clinical parameters that showed statistical differences between patients with UDT and LDT-CD were: Age: 29.8+/-13.8 vs. 49.8+/-17 years (p=0.035), BMI: 19.6+/-3.6 vs. 22.6+/-4.9 kg/m2 (p=0.001) and platelets count: 561.4+/-242 vs. 408+/-165/mm3 (p=0.021), respectively. Patients with UDT-CD had more frequency of dysphagia, odinophagia and oral ulcers when compared with LDT affected patients. Six patients had esophageal involvement, three showed oral lesions,two pharyngeal ulcers and one duodenal ulcer. In all but one patient lesions in the distal part were concomitantly detected. Thus only in one case isolated UDT involvement was observed. CONCLUSIONS: Mexicans patients with UDT-CD were younger, had a lower BMI and a higher platelets count when compared with LDT-CD patients. Solitary lesions in esophagus, stomach and duodenum are rare, occurring only in 1 of the 72 cases (3%). Dysphagia, odinophagia and oral ulcers must be a warning about the possibility of CD in the UDT portions.

Gastric capacity is related to body mass index in obese patients. A study using the water load test.

BACKGROUND: The role of gastrointestinal function in obesity is unknown. Recent studies have shown that satiety in obese patients is influenced by an abnormal gastric capacity. AIM: An easy and non-invasive tool, the water load test (WLT) was used to evaluate gastric capacity and how it relates to body mass index (BMI) in obese patients. METHODS: The WLT was performed in 32 patients with high BMI and 12 healthy volunteers. Water was ingested at a 15 mL/min rate. The maximal tolerable volume (MTV) was defined as the total ingested volume when patients stopped the test. RESULTS: A BMI > 30 was significantly associated with higher water consumption (2339 ± 306 mL) compared to controls (1830 ± 240 mL, p = 0.001). The MTV had a positive correlation with BMI (r = 0.68, p = 0.001). CONCLUSIONS: Obese subjects have an increased gastric capacity, as measured with the WLT. This greater drinking capacity has a positive correlation with the subjects' BMI.