Noncardiac Chest Pain?Prevalence and Treatment

Noncardiac chest pain (NCCP), which isdefined as recurrent episodes of angina-likeretrosternal chest pain in patients without cardiacdisease, is associated with significant morbidityand economic burden. In the August2004 issue of Current Treatment Options inGastroenterology, Wai-Man Wong, MD, andRonnie Fass, MD, reviewed the prevalenceand treatment of NCCP. The esophagus is themost common source for NCCP, and, of theesophageal disorders, gastroesophageal refluxdisease (GERD)?which affects up to 60% ofpatients with NCCP?is the disorder that mostcommonly causes this condition.

Although many patients with NCCP reportheartburn and chest pain, some report onlychest pain. Treatments for NCCP include protonpump inhibitor therapy, which is the mosteffective medical treatment for GERD-relatedNCCP. Therapies used for non?GERD-relatedNCCP include pain modulators (such as tricyclicantidepressants, trazodone, and selectiveserotonin [5-hydroxytryptamine; 5-HT] reuptakeinhibitors) and, in a subset of patients,cognitive behavioral therapy. The authors concludedthat newer agents, such as theophyllineand selective 5-HT type 4 (5-HT4) receptor agonists,may supplement or replace current treatmentsfor non?GERD-related NCCP.