Abstract
Noncardiac chest pain (NCCP) is a major source of healthcare expenditure and disability. Recent data indicate that 5.5 million patients visited emergency departments in the United States with the chief complaint of chest pain during 2007–2008. Chest pain is the second most common cause for emergency room visits after abdominal pain. NCCP is one of the most frequent causes of hospital admission in the Western world. In England and Wales, acute chest pain is responsible for approximately 700,000 patient visits annually at emergency departments and 20–30 % of emergency medical admissions.
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Key References
Achem SR. Noncardiac chest pain-treatment approaches. Gastroenterol Clin North Am. 2008;37:859–78. Comprehensive review of available therapeutic options.
Fass R, Achem SR. Noncardiac chest pain: Diagnostic evaluation. Dis Esophagus. 2012;25:89–101. Informative review of diagnostic tests available to the practicing clinician to assess patients with NCCP.
Fass R, Achem SR. Noncardiac chest pain: epidemiology, natural course and pathogenesis. J Neurogastroenterol Motil. 2011;17:110–23. Comprehensive review of available literature coving NCCP epidemiology, natural history, and pathogenesis.
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Teaching Questions
Teaching Questions
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1.
After reviewing the case study presentation, which one of the following would you recommend as the initial therapy or test?
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(A)
Reassurance
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(B)
Esophageal manometry
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(C)
Nitrates
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(D)
High-dose proton pump inhibitor trial for 8–10 days
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(A)
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2.
This patient was treated with omeprazole 20 mg 30 min before breakfast and dinner for 8 weeks without significant chest pain improvement. At this time, which one of the following would you recommend?
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(A)
Switch to another PPI
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(B)
Esophageal pH testing while off acid suppressive medication
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(C)
High-resolution esophageal manometry
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(D)
Botulinum toxin injection into the distal esophagus
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(A)
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3.
A high-resolution esophageal motility test is completely normal. The patient continues to experience recurrent chest pain. Which one of the following would you suggest next?
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(A)
Psychiatric referral
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(B)
Calcium blockers
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(C)
Hypnosis
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(D)
Visceral analgesic therapy
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(A)
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Achem, S.R. (2015). Noncardiac Chest Pain. In: Lacy, B., Crowell, M., DiBaise, J. (eds) Functional and Motility Disorders of the Gastrointestinal Tract. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1498-2_3
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DOI: https://doi.org/10.1007/978-1-4939-1498-2_3
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