title: Treatment of esophageal (noncardiac) chest pain: an expert review.
abstract: OBJECTIVE
  Chest pain is a common and frightening symptom. Once cardiac disease has been excluded, an esophageal source is most likely. Pathophysiologically, gastroesophageal reflux disease, esophageal dysmotility, esophageal hypersensitivity, and anxiety disorders have been implicated. However, treatment remains a challenge. Here we examined the efficacy and safety of various commonly used modalities for treatment of esophageal (noncardiac) chest pain (ECP) and provided evidence-based recommendations.
  
  
  METHODS
  We reviewed the English language literature for drug trials evaluating treatment of ECP in PubMed, Cochrane, and MEDLINE databases from 1968-2012. Standard forms were used to abstract data regarding study design, duration, outcome measures and adverse events, and study quality.
  
  
  RESULTS
  Thirty-five studies comprising various treatments were included and grouped under 5 broad categories. Patient inclusion criteria were extremely variable, and studies were generally small with methodological concerns. There was good evidence to support the use of omeprazole and fair evidence for lansoprazole, rabeprazole, theophylline, sertraline, trazodone, venlafaxine, imipramine, and cognitive behavioral therapy. There was poor evidence for nifedipine, diltiazem, paroxetine, biofeedback therapy, ranitidine, nitrates, botulinum toxin, esophageal myotomy, and hypnotherapy.
  
  
  CONCLUSIONS
  Ideally, treatment of ECP should be aimed at correcting the underlying mechanism(s) and relieving symptoms. Proton pump inhibitors, antidepressants, theophylline, and cognitive behavioral therapy appear to be useful for the treatment of ECP. However, there is urgent and unmet need for effective treatments and for rigorous, randomized controlled trials.
authors.affiliation: Section of Gastroenterology and Hepatology, Georgia Regents University, Augusta, Georgia.
authors.forename: Enrique
authors.initials: E
authors.lastname: Coss-Adame
authors.affiliation: Section of Gastroenterology and Hepatology, Georgia Regents University, Augusta, Georgia.
authors.forename: Askin
authors.initials: A
authors.lastname: Erdogan
authors.affiliation: Section of Gastroenterology and Hepatology, Georgia Regents University, Augusta, Georgia. Electronic address: srao@gru.edu.
authors.forename: Satish S C
authors.initials: SS
authors.lastname: Rao
mesh_terms: D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002637:Chest Pain / Q000209:etiology* / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D004935:Esophageal Diseases / Q000628:therapy*; D006801:Humans; D054328:Proton Pump Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D058915:Purinergic P1 Receptor Antagonists / Q000009:adverse effects / Q000627:therapeutic use; D013806:Theophylline / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D054328:Proton Pump Inhibitors; D058915:Purinergic P1 Receptor Antagonists; D013806:Theophylline
keywords: Behavioral Therapy; Esophageal Chest Pain; GERD; Hypersensitivity; Noncardiac Chest Pain Treatment