Evaluation and Management of Noncardiac Chest Pain / 胃肠病学

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.