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Query: UMLS:C0008031 (chest pain)
 17,248 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Noncardiac chest pain is a heterogeneous condition for which diagnosis and treatment are challenging. Research is needed to streamline evaluation to minimize unnecessary invasive testing and costs. Chest pain clinics to assess chest pain patients are popular in the United States and may be of value in reassuring patients and reducing presentation to hospital; however, recently this has been contended [111]. Options for the effective treatment of NCCP are dependent on the risk of an adverse outcome and the cost-effectiveness of the management algorithm that is followed. Most (64%) of those presenting to the emergency department with chest pain are classified as having NCCP [112,113]. GERD is probably the most important cause and application of a test of acid suppression with a high-dose PPI for 1 to 2 weeks seems to be a useful diagnostic tool. In those patients with GERD-related NCCP, short-term and potentially long-term therapy with a PPI (commonly higher than standard dose) is required to alleviate symptoms. Esophageal dysmotility is relatively uncommon in patients with NCCP and evaluation by esophageal manometry might be limited to rule out achalasia. Chest wall syndromes are common but probably often missed. Many patients with NCCP have psychologic or psychiatric abnormalities, as either the cause or an effect of the chest pain, but diagnosis here depends on techniques not applied easily in the acute situation. Pain modulators seem to offer significant improvement in chest pain symptoms for non-GERD-related NCCP. Finally, trials of management strategies to deal with this problem are required urgently, because the earlier discharge of patients with NCCP may exacerbate the problem. Fig. 2 provides a flow chart for diagnosis and treatment of NCCP.
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PMID:Noncardiac chest pain: evaluation and treatment. 1285 5

Evidence indicates that there is a strong cardioesophageal connection inpatients who experience esophageal or ischemic problems. Cardiologists and gastroenterologists often find the coexistence of symptoms and functional abnormalities, but determining causation is much more difficult. There isa need for better understanding of the phenomenon of cardiac and NCCP,among cardiologists and gastroenterologists. In evaluating chest pain, the cardiologist assesses the probability that the condition is acute and life threatening; serious and chronic; or noncardiac in nature. If it seems to be cardiac chest pain, appropriate therapy is initiated. In patients in whom there is a strong suspicion of NCCP, a PPI is often prescribed, or the patient is referred to a gastroenterologist or a primary care physician for further evaluation.
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PMID:Evaluation of chest pain: a cardiology perspective for gastroenterologists. 1506 35

Emerging data suggest that noncardiac chest pain (NCCP) is a very common disorder of international proportions. In the United States alone, an estimated 69 million patients suffer from NCCP. The clinical spectrum of patients with NCCP being referred to gastroenterologists seems to be changing to those failing to respond acid inhibition therapy or those who may not have gastroesophageal reflux (GER) in the first place. For these individuals there is an important need to find effective therapeutic options. These patients are the subject of the study that appears in this issue of The American Journal of Gastroenterology (Rao et al.,). Rao et al. report data from their tertiary center on consecutive patients with recurrent NCCP failing an 8-wk therapeutic trial of double-dose PPI or lacking evidence of GER on 24-h pH testing. They found that theophylline--a nonspecific adenosine receptor antagonist--when compared with placebo, improved the biomechanical and sensory properties of the esophageal wall and chest pain frequency, severity, and duration. This study underscores the potential role of adenosine receptors in visceral pain.
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PMID:New frontiers for the treatment of noncardiac chest pain: the adenosine receptors. 1731 94

In adults, several extra-digestive manifestations (cough, asthma, angina-like chest pain, ENT symptoms, dental erosions and even sleep disturbances) may be due to gastro-oesophageal reflux disease (GORD). In some cases, symptoms are triggered by an oesophageal reflex vagally mediated, while other symptoms are mainly related to the irritant effect of the refluxed material. The link with GORD is often difficult to establish because of the lack of typical digestive symptoms of GORD and of erosive oesophagitis in most of the cases. An empirical trial of double dose PPI therapy for 2 to 3 months can be done as the initial step in the diagnosis and treatment while oesophageal 24-hour pH monitoring is recommended by others to establish a temporal relationship between symptoms and reflux events. The optimal management algorithm remains to be determined. In some case, oesophageal luminal impedance monitoring could be useful to demonstrate a link between symptoms and a non-acid GORD. Traditionally, management of extra-oesophageal GORD manifestations relies on prolonged high doses of PPIs but the symptomatic efficacy of such treatment has been discussed recently. In case of adequate response, treatment can be tapered down to determine the minimal required maintenance dose. Anti-reflux surgery could be an alternative in some cases.
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PMID:[Extra-esophageal manifestations of gastroesophageal reflux disease in adults]. 1892 24

Gastroesophageal reflux disease (GERD) may manifest typically with heartburn and regurgitation or may have atypical manifestations as laryngitis, asthma, chronic cough or noncardiac chest pain (NCCP). While typical GERD is easy to be recognized, the atypical extraesophageal symptoms of the disease make the diagnosis difficult because most patients do not have heartburn or regurgitation. Most common atypical manifestations include ear, nose and throat (ENT), pulmonary or cardiac symptoms. GERD should be included in the differential diagnosis of patients with atypical symptoms, especially when alternative diagnoses are excluded. NCCP is defined as recurring angina-like substernal chest pain of noncardiac origin. We present the most recent epidemiologic data, pathophysiology, diagnosis and treatment of NCCP. The major causes of NCCP are GERD and esophageal dysmotility. By far, GERD has been demonstrated to be the most frequent source of NCCP. After a complete cardiac evaluation, the patient with NCCP will be referred to a gastroenterologist. All recent studies suggest the use of PPI test as the first diagnostic tool in patients with NCCP. The invasive diagnostic tests (especially, the 24-hour pH monitoring and esophageal manometry) are used only in those cases who do not respond to PPI therapy. Patients with GERD-related NCCP require long-term treatment with a PPI.
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PMID:[Noncardiac chest pain and gastroesophageal reflux disease]. 2070 Sep 64

GER is a common condition affecting many patients in different parts of the world. It usually presents with the classic manifestations of heartburn and regurgitation; however, in some it can also present with extraesophageal manifestations such as chronic cough, laryngitis, asthma or chest pain. Commonly employed diagnostic tests such as EGD and ambulatory pH or impedance monitoring in GER, are less useful in extraesophageal syndromes due to their poor sensitivity and specificity. In contrast, empiric trials of PPI's are shown to be cost effective; however, patients may require long-term treatment to establish effectiveness. Diagnostic testing with pH and impedance monitoring are commonly reserved for patients with partial or poor response to the initial treatment with PPI's. Poor response to PPI therapy may be an important indicator for non-GER causes for patients' symptoms and should initiate a search for other potential causes.
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PMID:Extraesophageal manifestations of gastroesophageal reflux disease: cough, asthma, laryngitis, chest pain. 2244 97

This paper presents commentaries on whether Starling's law applies to the esophagus; whether erythromycin affects esophageal motility; the relationship between hypertensive lower esophageal sphincter and vigorous achalasia; whether ethnic- and gender-based norms affect diagnosis and treatment of esophageal motor disorders; health care and epidemiology of chest pain; whether normal pH excludes esophageal pain; the role of high-resolution manometry in noncardiac chest pain; whether pH-impedance should be included in the evaluation of noncardiac chest pain; whether there are there alternative therapeutic options to PPI for treating noncardiac chest pain; and the usefulness of psychological treatment and alternative medicine in noncardiac chest pain.
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PMID:Nonspecific motility disorders, irritable esophagus, and chest pain. 2411 37

Non-cardiac chest pain (NCCP) is defined as recurring, angina-like, chest pain of non-cardiac origin. Studies have estimated that gastroesophageal reflux disease (GERD) is the most common contributing factor for NCCP. In patients with non-GERD related NCCP, esophageal motility disorders, and functional chest pain of presumed esophageal origin are the main underlying mechanisms for symptoms. Epidemiologic studies show a high prevalence of panic disorder, anxiety and major depression in NCCP patients. The diagnostic esophageal workup starts only after that cardiac and pulmonary diseases have been ruled out. NCCP patients with typical reflux symptoms are more likely to have GERD-related NCCP than those without typical reflux symptoms. High-dose proton pump inhibitor trial (PPI test) can be used to confirm the diagnosis of GERD-related NCCP. Negative upper endoscopy is quite common. For patients unresponsive to antireflux treatment and with negative endoscopy, impedance-pH monitoring should be done. Treatment of patients with non-GERD-related NCCP has focused on esophageal (hypercontractile or spastic) motility disorders and esophageal visceral hypersensitivity. In the first case, several trials using calcium channel blockers, nitrates, anticholinergics, or botulinum toxin injection and recent trials with endoscopic myotomy have been conducted. In case of visceral hypersensitivity, studies found that the amelioration, when compared to placebo, was significant with venlafaxine, sertraline, and imipramine. In this context, also cognitive behavioral therapy has been proposed.
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PMID:Non-cardiac chest pain: a 2018 update. 2964 92