Review article: the current treatment of non-cardiac chest pain
George N, et al.
Published in Alimentary Pharmacology & Therapeutics
Methodology
Review article using electronic searching of PubMed, Medline and the Cochrane Central register plus manual searching to appraise medical, endoscopic, surgical and psychological treatments for non-cardiac chest pain.
Key Findings
This narrative review of non-cardiac chest pain concludes that two months of double-dose proton pump inhibitor is a reasonable first-line approach because reflux disease is the most common cause. Muscle relaxants such as calcium channel blockers, nitrates and sildenafil have only limited value in patients with hypercontractile oesophageal motility. Pain modulators appear effective in both dysmotility-related and functional chest pain, though most supporting trials are small and many lack placebo control. Cognitive behavioural therapy has been extensively studied with good results, while hypnotherapy, group therapy and coping skills have been studied far less but appear helpful.
Conclusions
Medical, endoscopic and surgical therapeutic options are available for the treating physician, although some patients with non-cardiac chest pain may require a multimodal therapeutic approach.
Limitations
A narrative review based on electronic and manual searching without formal systematic methods, risk of bias assessment or pooled effect estimates; the underlying pain modulator trials are small and often uncontrolled.
Related Health Concerns
Study Details
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