GASTROENTEROLOGY ARTICLE OF THE WEEK
February 2, 2012
Arora AS, Katzka DA. How to I Handle the patient with Non-cardiac chest pain? Clin Gastroenterol Hepatol 2011;9:295-304.
1. Nutcracker esophagus
a. Is characterized by high amplitude, non peristalstic, long duration contractions
b. Is characterized by high amplitude (>180 mmHg), normal duration, peristaltic contractions
c. Is associated with lack or incomplete relaxation of the LES
d. When present, it is usually associated with non-cardiac chest pain
True or False
2. Chest pain in patients with achalasia is almost always caused by high amplitude simultaneous contractions of the esophagus.
3. Esophageal manometry is not helpful in the evaluation of patients with non-cardiac chest pain.
4. Upper endoscopy is the diagnostic modality of choice to determine the etiology of non-cardiac chest pain
5. Patients with normal esophageal acid exposure by pH monitoring but with a positive symptom index for heartburn are classified as having hypersensitive esophagus, and often respond to acid suppression
6. Esophageal spasm is the most common cause of non-cardiac chest pain
7. Patients with chest pain and documented history of coronary artery disease and cardiac angina do not benefit from PPI therapy
8. Hypersensitive esophagus and functional heartburn are two terms that describe the same condition
9. Double dose PPI as a “diagnostic tool” in chest pain should be given for a minimum of 3 months
10. Patients with achalasia and severe chest pain, often obtain relief of pain after myotomy or boutlinum toxin injection
11. Low
dose tricyclic antidepressant therapy trial is recommended for the treatment of
functional heartburn and hypersensitive esophagus