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Chronischer Brustschmerz

Chronic chest pain

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Zusammenfassung

Hintergrund

Im Brustkorb lokalisierte Beschwerden werden von Personen der allgemeinen Bevölkerung häufig angegeben und stellen eine differenzialdiagnostische Herausforderung dar.

Material und Methoden

Narrative Übersicht mit selektiver Literatursuche in der Datenbank Medline nach Übersichtsarbeiten und Leitlinien zur Häufigkeit und Therapie von nichtmalignen Erkrankungen aus der Gastroenterologie, Gynäkologie und Kardiologie mit Leitsymptom eines im Brustkorb lokalisierten chronischen Schmerzes.

Ergebnisse

Häufigkeit, Beschwerdebild und aktuelle Behandlungskonzepte der verschiedenen Formen der Refluxösophagitis (erosive und nichterosive Form, irritabler Ösophagus), des nichtkardialen Brustschmerzes, der refraktären Angina pectoris bei koronarer Herzerkrankung sowie des Postmastektomie- und Poststernotomiesyndroms werden dargestellt. Im Falle des Versagens der etablierten gebietsbezogenen Therapie ist eine interdisziplinäre einschließlich psychosoziale Diagnostik empfehlenswert. Zur Behandlung der Refluxösophagitis und der refraktären Angina pectoris bei koronarer Herzerkrankung liegen evidenzbasierte Leitlinien vor. Die Behandlung des Postmastektomie- und Poststernotomiesyndroms stützt sich auf Fallberichte und Expertenmeinungen.

Schlussfolgerungen

Es besteht Forschungsbedarf zur symptomatischen Schmerztherapie des irritablen Ösophagus, des nichtkardialen Brustschmerzes sowie des Postmastektomie- und Poststernotomiesyndroms.

Abstract

Background

Chest pain is a symptom commonly reported by persons in the general population and represents a differential diagnostic challenge.

Material and methods

The paper is based on a narrative review with a selective search of the literature in Medline for reviews and guidelines on the prevalence and treatment of non-malignant diseases with chronic chest pain in gastroenterology, gynecology and cardiology.

Results

The prevalence and current treatment recommendations for the different forms of gastroesophageal reflux disease (GERD), erosive and non-erosive types and irritable esophagus, non-cardiac chest pain, refractory angina in coronary heart disease and postmastectomy nand poststernotomy syndromes are presented. In cases of failure of the established therapy of a single medical discipline, an interdisciplinary assessment including psychosocial issues is recommended. Evidence-based guidelines are available for the management of GERD and of refractory angina. Treatment of postmastectomy and poststernotomy syndromes is based on case reports and expert opinion.

Conclusion

There is a need for controlled studies on the symptomatic treatment of pain in irritable esophagus, non-cardiac chest pain, postmastectomy and poststernotomy syndromes.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. W. H. erhielt ein Beratungshonorar von Daiichi Sankyo und Vortragshonorare von Abbott Deutschland, MSD Sharpe & Dohme und Pfizer in den letzten 3 Jahren. D. G. führt AMTS-Projekte mit der Barmer GEK, Knappschaft-Bahn-See, IKK Südwest und dem Saarländischen Gesundheitsministerium durch. Er ist Mitglied des wissenschaftlichen Beirats von RpDoc Solutions GmbH; D. G. hat keine Interessenkonflikte anzugeben. Der Beitrag enthält keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Innere Medizin II, Klinikum Saarbrücken gGmbH, Saarbrücken, Deutschland

    G. Görge

  2. Innere Medizin I, Klinikum Saarbrücken gGmbH, Winterberg 1, 66119, Saarbrücken, Deutschland

    D. Grandt &  W. Häuser

  3. Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Technische Universität München, München, Deutschland

    W. Häuser

Authors
  1. G. Görge
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  2. D. Grandt
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  3. W. Häuser
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Correspondence to W. Häuser.

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Görge, G., Grandt, D. & Häuser, W. Chronischer Brustschmerz. Schmerz 28, 282–288 (2014). https://doi.org/10.1007/s00482-014-1405-7

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  • DOI: https://doi.org/10.1007/s00482-014-1405-7

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