Diagnosis and Management of Functional Chest Pain in the Rome IV Era

Abstract

Functional chest pain accounts for about a third of the patients with noncardiac chest pain. It is a very common functional esophageal disorder that remains even today a management challenge to the practicing physician. Based on the definition offered by the Rome IV criteria, diagnosis of functional chest pain requires a negative workup of noncardiac chest pain patients that includes, proton pump inhibitor test or empirical proton pump inhibitor trial, endoscopy with esophageal mucosal biopsies, reflux testing, and esophageal manometry. The mainstay of treatment are neuromodulators that are primarily composed of anti-depressants. Alternative medicine and psychological interventions may be provided alone or in combination with other therapeutic modalities.

Demographic and Clinical Characteristics of Patients with Nutcracker Esophagus

“…In this study, it is interesting to note that the primary complaint of chest pain was observed in allof the group C, whereas those with low DEA had less chest pain and more dysphagia (2). However, no significant correlation was found between the patients' symptoms and their DEA levels in other studies (6,8,17). For instance, in a study conducted by Richter et al, no improvement in symptoms was observed, although high DEA levels decreased to normal with nifedipine treatment in patients with NE (19).…”

“…While some studies report that the symptoms observed in patients with NCCP are not correlated with high-amplitude contractions (14), it has been reported in several studies the amplitudes of contractions decreased to normal values due to treatments (calcium channel blockers, nitrates, botulinum injection, etc. ), yet symptoms did not improve (8,14,15).…”

“…The imbalance between stimulant and inhibitory neurons of the esophagus (3), abnormal autonomic innervation of the esophagus and hypercholinergic outcome (3,4), thickening of the esophageal This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as: Öztürk www.erciyesmedj.com muscular layer (5,6), or induced hypertensive contractions due to gastroesophageal reflux disease (GERD) are all reasons for the pathogenesis of the disease (7,8). It has also been shown that acute stress causes high-amplitude contractions in the esophagus (9).…”

“…In another study, Mittal et al (14) suggested retraction of GERD before considering the diagnosis of NE. It has also been suggested that NE is an esophageal motility abnormality that occurs in those with GERD(8). While Agrawal et al(2) detected reflux in 77% of patients with low DEA (DEA <210 mmHg), they detected reflux in only 19% of patients with high DEA (> 260 mmHg).…”

“…et al(8) reported that gastroesophageal reflux disease (GERD) symptoms are prominent in many NE patients. They reported that chest pain decreased in 83% of patients with NE who were administered omeprazole therapy.…”