| International Session (Symposium) 5 (JSGE・JGES) |
| Fri. November 2nd 9:40 - 12:00 Room 13: Kobe International Conference Center International Conference Room |
| Mechanism, diagnosis and management of NCCP | |||
| Daniel Sifrim | |||
| Barts and the London School of Medicine, Queen Mary, University of London | |||
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| Patients presenting to emergency departments and to cardiologists with chest pain and subsequently having entirely negative cardiac investigations were presumed to have "non-cardiac" chest pain. This was thought to be mostly esophageal in origin and several studies have shown most have chest pain due to GERD or motility disorders. Only a proportion of these patients are subsequently diagnosed with functional chest pain Diagnosis - the diagnosis of functional chest pain starts with exclusion of cardiac causes. due to the possible lethal nature of untreated ischemic heart disease and unstable angina. Once a cardiac cause has been excluded, esophageal causes of chest pain should be reviewed. Often a PPI trial is commenced and if there is no response, gastroscopy is performed to exclude malignancy, esophagitis or eosinophilic esophagitis. If no cause is not found, high-resolution manometry and 24-hour MII-pH studies are performed to exclude increased acid reflux and severe esophageal motility disorders. Treatment - Several pharmacological agents have been evaluated. These include TCAs, SNRIs and non-pharmacological interventions. Amitriptyline, Venlafaxine, Imipramine, SSRIs-Sertraline, Paroxetine have shown to help patients with non-cardiac chest pain in randomized placebo controlled trials. Non-pharmacological interventions - Biofeedback therapy, Johrei, Cognitive behavioral therapy - have been used to treat non-cardiac chest pain. Other therapies - there have been randomized controlled trials using theophylline, and hypnotherapy showing them to be effective in the treatment of non-cardiac chest pain. |
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