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Non-cardiac chest pain: a 2018 update
Marilena Durazzo1, Giuseppe Gargiulo2, Rinaldo Pellicano3
1Department of Medical Sciences, University of Turin, Turin, Italy - marilena.durazzo@unito.it.
Minerva Cardioangiologica
|April 13, 2018
Summary
Non-cardiac chest pain (NCCP) often stems from gastroesophageal reflux disease (GERD). For non-GERD NCCP, esophageal motility issues or visceral hypersensitivity are key, with various treatments showing promise.
Area of Science:
- Gastroenterology
- Digestive Health
- Esophageal Disorders
Background:
- Non-cardiac chest pain (NCCP) is chest pain not originating from the heart.
- Gastroesophageal reflux disease (GERD) is the most frequent cause of NCCP.
- Esophageal motility disorders and functional chest pain are common in non-GERD NCCP.
Purpose of the Study:
- To review the causes and diagnostic approaches for NCCP.
- To explore treatment strategies for GERD-related and non-GERD-related NCCP.
- To highlight the role of esophageal dysfunction and psychological factors in NCCP.
Main Methods:
- Review of studies on NCCP etiology and diagnosis.
- Analysis of diagnostic tools including PPI trials and impedance-pH monitoring.
- Examination of treatment outcomes for esophageal motility disorders and visceral hypersensitivity.
Main Results:
- GERD is the leading cause of NCCP, often confirmed by a high-dose proton pump inhibitor (PPI) trial.
- Esophageal motility disorders and visceral hypersensitivity are primary mechanisms in non-GERD NCCP.
- Pharmacological agents (e.g., PPIs, antidepressants) and therapies (e.g., CBT) show efficacy.
Conclusions:
- Accurate diagnosis of NCCP requires ruling out cardiac causes and assessing esophageal involvement.
- GERD-related NCCP is diagnosed via PPI trials, while non-GERD NCCP involves motility disorders or hypersensitivity.
- Effective NCCP management includes targeted therapies for GERD, motility issues, hypersensitivity, and psychological comorbidities.
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