title: Systematic review: the treatment of noncardiac chest pain.
abstract: BACKGROUND
  Treatment of noncardiac chest pain (NCCP) remains a challenge. This is in part due to the heterogeneous nature of this disorder. Several conditions are associated with NCCP including gastro-oesophageal reflux disease (GERD), oesophageal dysmotility, oesophageal hypersensitivity as well as others.
  
  
  OBJECTIVE
  To determine the currently available therapeutic modalities for NCCP.
  
  
  METHODS
  We performed a systematic review of the literature that was published between January, 1980 and March, 2011. We identified 734 studies; 68 of them met entry criteria.
  
  
  RESULTS
  Patients with GERD-related NCCP should receive proton pump inhibitors (PPI) twice daily for at least 8 weeks. Smooth muscle relaxants are only recommended for temporary relief of NCCP with motility disorders. Botulinum toxin injection of the distal oesophagus may be effective in the treatment of NCCP and spastic oesophageal motility disorders. Studies assessing the value of tricyclic antidepressants, trazodone and selective serotonin reuptake inhibitors in NCCP are relatively small, but suggest an oesophageal analgesic effect in NCCP patients that is limited by their side effects profile. The usage of theophylline to treat patients with non-GERD-related NCCP should be weighed against its potential toxicity. Use of complementary medicine has been scarcely studied in NCCP. Patients with coexisting psychological morbidity or those not responding to any medical therapy should be considered for psychological intervention. Cognitive behavioural therapy and hypnotherapy may be useful in the treatment of NCCP.
  
  
  CONCLUSIONS
  Patients with GERD-related noncardiac chest pain should be treated with at least double dose PPI. The primary treatment for non-GERD-related noncardiac chest pain, regardless if oesophageal dysmotility is present, is pain modulators.
authors.affiliation: The Neuroenteric Clinical Research Group, Southern Arizona VA Health Care System, Tucson, AZ 85723-0001, USA.
authors.forename: T
authors.initials: T
authors.lastname: Hershcovici
authors.forename: S R
authors.initials: SR
authors.lastname: Achem
authors.forename: L K
authors.initials: LK
authors.lastname: Jha
authors.forename: R
authors.initials: R
authors.lastname: Fass
mesh_terms: D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D002637:Chest Pain / Q000188:drug therapy* / Q000209:etiology; D003937:Diagnosis, Differential; D015154:Esophageal Motility Disorders / Q000150:complications / Q000188:drug therapy; D005764:Gastroesophageal Reflux / Q000150:complications / Q000188:drug therapy; D006801:Humans; D010147:Pain Measurement; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012720:Severity of Illness Index
chemical_list: D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors