GASTROENTEROLOGY ARTICLE OF THE WEEK
August 10, 2006
Dickman R, Fass R. Noncardiac chest pain. Clin Gastroenterol Hepatol 2006;4:558-563.
1. Non-cardiac chest pain (NCCP) and GERD
a. The most common cause of non-cardiac chest pain is esophageal spasm
b. Over 85% of patients with NCCP have abnormal 24h esophageal pH studies
c. Lack of improvement on once a day PPI does not exclude GERD as the cause of NCCP
d. The presence of esophagitis or abnormal 24h esophageal pH study is highly predictive that GERD is the cause of NCCP
True or False
2. Esophageal dysmotility is the most common cause of non-GERD related NCCP.
3. A careful clinical history can distinguish cardiac from non-cardiac chest pain
4. Improvement in NCCP in patients with nutcracker esophagus is usually associated with normalization of the esophageal dysmotility findings.
5. Optimal symptom control in GERD-related NCCP is usually achieved with 10-14 days of bid PPI therapy
6. Imipramine increases esophageal perception threshold for pain without affecting motility
7. In contrast to TCA’s, SSRI’s have no role in the treatment of NCCP.
8. A patient presenting with “typical” non-cardiac chest pain should undergo an upper endoscopy prior to referral for cardiac evaluation
9. Patients with NCCP who are found on motility study to have a non-specific dysmotility disorder respond better to pain modulators than to smooth muscle relaxants
10. Failure of response to one tricyclic antidepressant predicts non-response to other agents in the same class.