Noncardiac Chest Pain?Prevalence and Treatment

OCTOBER 01, 2004

Noncardiac chest pain (NCCP), which is defined as recurrent episodes of angina-like retrosternal chest pain in patients without cardiac disease, is associated with significant morbidity and economic burden. In the August 2004 issue of Current Treatment Options in Gastroenterology, Wai-Man Wong, MD, and Ronnie Fass, MD, reviewed the prevalence and treatment of NCCP. The esophagus is the most common source for NCCP, and, of the esophageal disorders, gastroesophageal reflux disease (GERD)?which affects up to 60% of patients with NCCP?is the disorder that most commonly causes this condition.

Although many patients with NCCP report heartburn and chest pain, some report only chest pain. Treatments for NCCP include proton pump inhibitor therapy, which is the most effective medical treatment for GERD-related NCCP. Therapies used for non?GERD-related NCCP include pain modulators (such as tricyclic antidepressants, trazodone, and selective serotonin [5-hydroxytryptamine; 5-HT] reuptake inhibitors) and, in a subset of patients, cognitive behavioral therapy. The authors concluded that newer agents, such as theophylline and selective 5-HT type 4 (5-HT4) receptor agonists, may supplement or replace current treatments for non?GERD-related NCCP.