Current and future treatment of chest pain of presumed esophageal origin.
Patients with chest pain of presumed esophageal origin should be reassured and should undergo an esophageal manometry study. In patients with spastic esophageal disorders, a trial with calcium channel blockers or low-dose antidepressants used as visceral analgesics is the best approach. Inpatients with non GERD-related, nonspastic esophageal motility disorder, low-dose antidepressants seem reasonable. Anxiolytics are useful in patients with panic disorders, and psychological interventions (eg, cognitive-behavioral therapy) are also valuable, mainly in patients in whom reassurance is not sufficient to avoid the misinterpretation of their symptoms. In the future, visceral sensitivity modifying agents such as serotoninergic agonists or antagonists may become the cornerstone of therapy in patients with chest pain of presumed esophageal origin. Combinations of different approaches, such as proton pump inhibitors and psychotropic or antinociceptive agents, should also be evaluated in clinical trials.
Schmulson
Max J
MJ
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14000, Mexico. maxjulio@quetzal.innsz.mx
Valdovinos
Miguel Angel
MA
D001521:Behavior Therapy; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use; D002637:Chest Pain / Q000209:etiology / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D004947:Esophagus / Q000503:physiopathology; D005764:Gastroesophageal Reflux / Q000150:complications; D006801:Humans; D009125:Muscle Relaxants, Central / Q000627:therapeutic use; D009465:Neuromuscular Agents / Q000627:therapeutic use; D011619:Psychotropic Drugs / Q000627:therapeutic use
D018680:Cholinergic Antagonists; D009125:Muscle Relaxants, Central; D009465:Neuromuscular Agents; D011619:Psychotropic Drugs; D019274:Botulinum Toxins, Type A