Recent developments in chest pain of undetermined origin

Area of Science:

• Gastroenterology
• Cardiology
• Psychosomatic Medicine

Background:

• Chest pain with normal epicardial coronary arteries is a prevalent and costly clinical issue.
• Diagnosis is challenging, requiring exclusion of cardiac and musculoskeletal disorders before attributing pain to esophageal causes.
• Chest pain of undetermined origin (UCP) is a proposed term for this condition.

Purpose of the Study:

• To review the causes and management of chest pain in patients with normal coronary arteries.
• To highlight the shift in understanding esophageal pain from dysmotility to reflux as the primary cause.
• To discuss the roles of visceral hyperalgesia and psychological factors in UCP.

Main Methods:

• Review of clinical findings and treatment outcomes for patients presenting with angina-like chest pain and normal coronary arteries.
• Analysis of studies investigating the efficacy of acid suppressive agents and psychotropic medications.
• Consideration of the contribution of visceral hyperalgesia and psychological disturbances.

Main Results:

• Esophageal reflux is identified as the most common cause of esophageal pain, surpassing previous considerations of dysmotility.
• Omeprazole demonstrated effective pain relief in controlled trials for a majority of patients with chest pain.
• Visceral hyperalgesia and psychological disturbances are frequently observed in patients with UCP.
• Imipramine or trazodone provided relief for specific patient subgroups, and psychological interventions are beneficial.

Conclusions:

• Esophageal reflux is a primary target for treating chest pain of undetermined origin.
• Pharmacological interventions, including acid suppressants and certain psychotropic drugs, offer effective management options.
• Further research is needed to elucidate the mechanisms of visceral hyperalgesia and the role of psychological factors in UCP.