Non-cardiac chest pain: an update

Area of Science:

• Gastroenterology
• Internal Medicine

Background:

• Non-cardiac chest pain (NCCP) affects up to 25% of US adults, significantly impacting quality of life and healthcare resource utilization.
• NCCP is a heterogeneous condition with both gastrointestinal and non-gastrointestinal origins.
• While gastro-oesophageal reflux disease (GORD) is the most frequent cause, visceral hyperalgesia plays a crucial role in non-GORD related NCCP.

Purpose of the Study:

• To review the causes and management of non-cardiac chest pain.
• To highlight the shift in understanding NCCP etiology, emphasizing visceral hyperalgesia.
• To outline current therapeutic strategies for GORD-related and non-GORD related NCCP.

Main Methods:

• Literature review of recent studies on non-cardiac chest pain.
• Analysis of the role of gastro-oesophageal reflux disease (GORD) and visceral hyperalgesia in NCCP.
• Summary of current treatment modalities for different NCCP subtypes.

Main Results:

• Gastro-oesophageal reflux disease (GORD) remains the most common cause of NCCP.
• The significance of oesophageal dysmotility in NCCP has diminished in recent research.
• Visceral hyperalgesia is increasingly recognized as a key factor in non-GORD related NCCP symptom generation.

Conclusions:

• Effective management of NCCP requires accurate diagnosis of its underlying cause.
• Treatment strategies for NCCP should be tailored, utilizing antireflux therapies for GORD and pain modulators for visceral hyperalgesia.
• Further research into the mechanisms of visceral hyperalgesia in NCCP is warranted.