Screening and Identifying Erosive Esophagitis in Children with Non-cardiac Chest Pain

Aetiological evaluation of chest pain in childhood and adolescence

BACKGROUND

Chest pain, as a common cause of hospital admissions in childhood, necessitates detailed investigations due to a wide range of differential diagnoses. In this study, we aimed to determine the distribution of diseases causing chest pain in children and investigate the clinical characteristics of children with chest pain.

METHODS

This study included 782 patients aged between 3 and 18 years who presented to a paediatric cardiology outpatient clinic with chest pain between April 2017 and March 2018. Aetiological causes and demographic features of the patients were analysed.

RESULTS

Most prevalent causes of chest pain were musculoskeletal system (33%) and psychogenic (28.4%) causes. Chest pain due to cardiac reasons was seen in eight patients (1%). Diseases of musculoskeletal and gastrointestinal systems and psychogenic disorders were significantly more common in male and female patients, respectively (p < 0.001 for all). In winter, patients' age and the number of patients with ≥12 years were higher than those in other seasons (p < 0.001). Most of the parents (70.8%) and patients (90.2%) thought that chest pain in their children was caused by cardiac causes.

CONCLUSION

Most of the diagnoses for chest pain in childhood period are benign and include the musculoskeletal system and psychogenic diseases. Although chest pain due to cardiac diseases is rare, a comprehensive analysis of medical history, detailed physical examination and cardiac imaging with echocardiography is needed to reach more accurate diagnoses.

The evaluation of adolescent chest pain: a screening ECG or PSC-17?

PURPOSE OF REVIEW

The present review offers an update on entities presenting as chest pain in the adolescent population. It discusses recently proposed tools and shared mental models used in primary and urgent care settings to evaluate chest pain, and their focus on identifying life-threatening processes. We consider whether the current practice may be improved by accounting for the increasingly recognized non-life-threatening causes of adolescent chest pain.

RECENT FINDINGS

The present experiences and behaviors of adolescents have added new causes of chest pain to the work-up of this disquieting chief complaint. The initial approach to adolescent chest pain has classically focused on ruling out life-threatening entities, and current diagnostic algorithms offer systematic approaches with similar emphases. A growing body of literature on the nonlife-threatening causes of adolescent chest pain, often categorized as idiopathic, suggests a need to reevaluate our practice.

SUMMARY

Adolescent chest pain is most often noncardiac and non-life threatening in nature, yet current diagnostic algorithms and evaluations emphasize identifying the exceptional case of cardiac chest pain. Familiarizing ourselves with the more common causes of chest pain and with our present approach to the evaluation of this particular chief complaint, may help us to better counsel our patients and avoid unnecessary use of valuable resources.