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KMID : 0614620150650020000
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Korean Journal of Gastroenterology
2015 Volume.65 No. 2 p.0 ~ p.0
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Noncardiac Chest Pain: Update on the Diagnosis and Management
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Min Yang-Won
Rhee Poong-Lyul
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Abstract
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Noncardiac chest pain (NCCP) is defined as recurring, angina-like, retrosternal chest pain of noncardiac origin. Although patients
with NCCP have excellent long-term prognosis, most suffer persistently from their symptoms. Several pathophysiological mechanisms
have been suggested, including gastroesophageal reflux disease (GERD), esophageal motility disorder, esophageal hypersensitivity,
and psychological comorbidity. Among them, GERD is the most common cause of NCCP. Therefore, GERD should
first be considered as the underlying cause of symptoms in patients with NCCP. Empirical proton pump inhibitor (PPI) treatment
with a preferably double dose for more than 2 months could be cost-effective. PPI test can also be used for diagnosis of
GERD-related NCCP, but it should be considered for patients with NCCP occurring at least weekly and its duration should
be at least 2 weeks. However, upper endoscopy and esophageal pH monitoring are necessary when the diagnosis of GERD
is uncertain. Esophageal impedance-pH monitoring could further improve the diagnostic yield. Patients with GERD-related NCCP
should preferably be treated with a double dose PPI until symptoms remit (may require more than 2 months of therapy for
optimal symptom control), followed by dose tapering to determine the lowest PPI dose that can control symptoms. However,
treatment of patients with non-GERD?related NCCP is challenging. An empirical treatment of antidepressants could be
considered. If there are specific esophageal motility disorders, smooth muscle relaxants or endoscopic treatment may be
considered in selected cases. If none of these traditional treatments is effective, a psychology consultation for cognitive behavioral
therapy should be considered.
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KEYWORD
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Diagnosis, Gastroesophageal reflux disease, Noncardiac chest pain (NCCP), Therapy
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