Distinct Characteristics of Noncardiac Chest Pain in Korea / 대한내과학회지

ABSTRACT

Gastroesophageal reflux disease (GERD) is the most common cause of noncardiac chest pain (NCCP) and was reported to cause 41% of cases of NCCP in a recent study of Korea. Typical reflux symptoms were reported to be frequent in Korean patients suffering from NCCP. Therefore, a careful history of the symptoms is relatively indicative of GERD diagnosis in Korea. In Korea, contrasting Western countries, patients with NCCP but present no alarm features should undergo endoscopy to exclude gastric cancer or peptic ulcer. In a primary care setting, PPI test is sufficient for the presumptive diagnosis of GERD. Specifically in Korea, the optimal duration of PPI test may be at least 2 weeks because of less frequent or atypical GERD symptoms. In patients diagnosed with GERD-related NCCP, the initial long term therapy (more than 2 months) followed to the maintenance therapy is required to alleviate symptoms. Esophageal dysmotility is relatively uncommon, and pain modulators seem to offer significant improvement in chest pain control in non GERD-related NCCP. Unfortunately, the majority of traditionally available tricyclics or heterocyclics have many undesirable effects. Therefore, newer drugs with fewer side effects may be needed, such as the serotonin-norepinephrine reuptake inhibitors.