Update on noncardiac chest pain

Sanjeeb Shrestha, Pankaj Jay Pasricha

Research output: Contribution to journalArticle

Abstract

Patients with recurrent angina-like chest pain with normal coronary vessels are deemed to have the syndrome of noncardiac chest pain (NCCP). These patients, despite having significant cardiac disease ruled out, often spend a restricted lifestyle believing they have cardiac disease. These recurrent episodes of chest pain may be related to gastroesophageal reflux disease (GERD), spastic motility disorders of the esophagus and esophageal (visceral) hyperalgesia. These disease entities are often difficult to diagnose and treat except for GERD and achalasia. Recent prospective double-blind studies have shown that about 44% of these patients may have underlying GERD. There is now more evidence to support the practice of empiric use of proton pump inhibitors (PPIs) as the first step in therapy. Newer modalities for diagnosis like endoscopic ultrasonography (EUS) showed that this group of patients had sustained muscular contractions of longer that 68 s during chest pain. These sustained contractions noted on EUS were secondary to isometric contraction of the circular muscle which did not cause luminal constriction nor was related to contraction of the longitudinal muscles which cannot be recorded by pressure manometry. Treatment is difficult if patients do not respond to high-dose PPIs. Other medications which are known to alter visceral hyperalgesia in low doses, such as tricyclic antidepressants like imipramine and desyrel, can be tried. Psychological intervention may be useful in the management of some of these patients.

Original languageEnglish (US)
Pages (from-to)138-146
Number of pages9
JournalDigestive diseases (Basel, Switzerland)
Volume18
Issue number3
DOIs
StatePublished - 2000
Externally publishedYes

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Chest Pain
Gastroesophageal Reflux
Endosonography
Proton Pump Inhibitors
Hyperalgesia
Muscle Contraction
Heart Diseases
Esophageal Motility Disorders
Trazodone
Esophageal Achalasia
Isometric Contraction
Muscle Spasticity
Imipramine
Tricyclic Antidepressive Agents
Manometry
Double-Blind Method
Constriction
Esophagus
Life Style
Coronary Vessels

Keywords

  • Esophageal hyperalgesia
  • Esophageal motor disorders
  • Gastroesophageal reflux disease
  • Irritable esophagus
  • Noncardiac chest pain

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Update on noncardiac chest pain. / Shrestha, Sanjeeb; Pasricha, Pankaj Jay.

In: Digestive diseases (Basel, Switzerland), Vol. 18, No. 3, 2000, p. 138-146.

Research output: Contribution to journalArticle

Shrestha, Sanjeeb ; Pasricha, Pankaj Jay. / Update on noncardiac chest pain. In: Digestive diseases (Basel, Switzerland). 2000 ; Vol. 18, No. 3. pp. 138-146.
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