ABSTRACT
Noncardiac chest pain (NCCP) is defined as a recurrent, angina⁃like chest pain after cardiac causes are excluded. It is a common and challenging problem in clinical practice that requires appropriate assessment to identify the underlying origin of the symptom. Gastroesophageal reflux disease (GERD), esophageal dysmotility and functional chest pain are the three main causes of NCCP. GERD is the most common cause of NCCP and should be evaluated first. Proton pump inhibitor (PPI) test, upper gastrointestinal endoscopy, 24 ⁃ hour esophageal pH ⁃ impedance monitoring are used to identify GERD⁃induced NCCP. High⁃resolution esophageal manometry is the main tool to identify esophageal dysmotility in non⁃GERD⁃related NCCP. Diagnosis of functional chest pain requires a negative cardiac workup, no response to PPI test, as well as no obvious abnormalities in upper gastrointestinal endoscopy with mucosal biopsy, esophageal pH ⁃ impedance monitoring and esophageal manometry. Treatment of NCCP is tailored according to the underlying mechanism that is responsible for the chest pain. PPI for GERD ⁃ related NCCP and smooth muscle relaxants for esophageal dysmotility are very commonly prescribed. Endoscopic and surgical interventions can also be considered in GERD and esophageal dysmotility related NCCP. For patients with functional chest pain, neuromodulators, mainly the antidepressants are the cornerstone of therapy.
ABSTRACT
Objective:To analyze the differences in the contraction pattern of esophageal body in patients with different types of non-cardiac chest pain (NCCP).Methods:From January 1, 2019 to December 31, 2020, 46 NCCP patients visited the First Affiliated Hospital of Zhejiang Chinese Medical University were selected. According to the Lyon consensus and Rome Ⅳ dignostic criteria, combined with the results of gastr oscopy and 24 h muitichannel intraluminal impedance combined with pH detection monitoring, 27 patients were finally included. The 27 patients were divided into functional chest pain group (12 cases) and gastroesophageal reflux disease (GERD) group (15 cases). The differences in contraction pattern of esophageal body between the two groups were analyzed according to the results of high-resolution esophageal manometry (the maximal wave amplitude of each contraction segment (S1, S2, S3), average contraction amplitude, contraction transmission time, segment lengths, distal contractile integral (DCI) and the DCI ratio of S2 to S3). Independent sample t test and chi-square test were used for statistical analysis. Results:The segment length and contraction transmission time of S3 in GERD group were shorter than those in functional chest pain group, the DCI of S3 in GERD group was lower than that in functional chest pain group, and the DCI ratio of S2 to S3 was higher than that of functional chest pain group ((5.69±0.55) cm vs. (6.61±0.99) cm, (3.45±0.49) s vs. (4.15±0.90) s, (798.88±354.70) mmHg·s·cm (1 mmHg=0.133 kPa) vs. (1 421.45±802.47) mmHg·s·cm, 0.99±0.44 vs. 0.67±0.17), and the differences were statistically significant ( t=2.682, 2.249, 2.308 and -2.616, all P<0.05). In GERD group, the transmitted segment length of S2 was longer than that of S3 ((7.02±1.40) cm vs. (5.69±0.55) cm), the contraction time of S2 of functional chest pain group was shorter than that of S3 ((3.29±0.80) s vs. (4.15±0.90) s), and the differences were statistically significant ( t=3.413 and -2.269, both P<0.05). Conclusion:High-amplitude contraction of S3 mainly occurs in patients with functional chest pain rather than GERD patients, suggesting that it may have a certain value in differential diagnosis of functional chest pain and GERD.
ABSTRACT
The Rome IV criteria, published in 2016, encompass upper gastrointestinal lesions of functional esophageal disorders and functional gastroduodenal disorders. Functional esophageal disorders include functional chest pain, functional heartburn, reflux hypersensitivity, globus, and functional dysphagia. Patients with functional esophageal disorders typically have esophageal symptoms that are not associated with structural, inflammatory, or major esophageal motor disorders. Although the mechanisms of symptom generation in functional esophageal disorders are unclear, visceral hypersensitivity and hypervigilance may play a role. Therefore, treatment options include drugs and modalities that affect peripheral triggering and central perception. Further well-designed studies are needed to identify the mechanisms of symptom generation in, and to develop appropriate therapies for, functional esophageal disorders.
Subject(s)
Humans , Anxiety , Chest Pain , Deglutition Disorders , Heartburn , Hypersensitivity , Motor DisordersABSTRACT
OBJECTIVE: To evaluate the clinical efficacy and safety of venlafaxine in treatment of functional chest pain (FCP). METHODS: In the randomized, double-blind, placebo-controlled clinical trial, 62 patients diagnosed with FCP was randomized to either trial group (venlafaxine, 75 mg·d-1, 32 patients) or control group (placebo, 30 patients) for six weeks. The patients were interviewed to finish symptom assessment, hospital anxiety and depression scale (HADS), and 36-item short form health survey (SF-36). RESULTS: On the intention-to-treat analysis (ITT) the effective rate of venlafaxine group was 71.4% and of placebo group was 14%. The difference between the two groups was significant after six weeks (χ=17.912, P<0.001). The scores of anxiety and depression of venlafaxine group was significantly lowered after treatment (P<0.05). On the completer analysis (CA), the difference was statistically significant within three dimensions of SF-36 including the Physical Role, Vitality and Emotional Role (P<0.05). Venlafaxine group had no significant side effect. CONCLUSION: Venlafaxine is safe and effective in treatment of functional chest pain. Copyright 2012 by the Chinese Pharmaceutical Association.