title: New therapies for non-cardiac chest pain.
abstract: After excluding a cardiac cause, potent anti-reflux therapy should be administered to patients with non-cardiac chest pain since gastroesophageal reflux disease (GERD) is the most common underlying mechanism of this disorder. If GERD is an unlikely cause of patient's symptoms, an esophageal motor disorder should be excluded. Spastic motility disorders can be treated with a smooth muscle relaxant (such as calcium channel blocker, nitrate, or phosphodiesterase 5 inhibitors). Alternatively, spastic motility disorders may respond to anti-spasmodics, pain modulators, botulinum toxin injection into the distal esophagus, and/or surgery. Patients with functional chest pain have recently seen an expanded treatment armamentarium including medications such as trazadone, tricyclic anti-depressants, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, pregabalin, and/or ramelteon.
authors.affiliation: The Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, Case Western Reserve University, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH, 44109-1998, USA.
authors.forename: Carla
authors.initials: C
authors.lastname: Maradey-Romero
authors.forename: Ronnie
authors.initials: R
authors.lastname: Fass
mesh_terms: D000700:Analgesics / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D001905:Botulinum Toxins / Q000627:therapeutic use; D002637:Chest Pain / Q000209:etiology* / Q000628:therapy*; D015154:Esophageal Motility Disorders / Q000150:complications / Q000628:therapy; D004947:Esophagus / Q000601:surgery; D005764:Gastroesophageal Reflux / Q000150:complications / Q000628:therapy; D006801:Humans
chemical_list: D000700:Analgesics; D000928:Antidepressive Agents; D001905:Botulinum Toxins
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