title: Review article: the current treatment of non-cardiac chest pain.
abstract: BACKGROUND
  Non-cardiac chest pain is one of the most common functional gastrointestinal disorders. By recognising that gastro-oesophageal reflux disease (GERD), oesophageal dysmotility and oesophageal hypersensitivity are the main underlying mechanisms of NCCP, a more directed therapeutic approach has been developed.
  
  
  OBJECTIVE
  To determine the value of the current therapeutic modalities for NCCP.
  
  
  METHODS
  Electronic (Pubmed/Medline/Cochrane central) and manual search.
  
  
  RESULTS
  Double-dose PPI treatment for two months is a reasonable first choice approach in patients with NCCP because GERD is the most common aetiology. Studies evaluating the role of medical therapy in NCCP patients with hypercontractile oesophageal motility suggest a limited value to muscle relaxants like calcium channel blockers (nifedipine, diltiazem), nitrates and sildenafil. While most trials evaluating pain modulators are small and many are not placebo-controlled, these type of medications appear efficacious in both patients with NCCP due to oesophageal dysmotility and those with functional chest pain. Cognitive behavioural therapy has been extensively studied in patients with functional chest pain with good results. Other psychological techniques such as hypnotherapy, group therapy or coping skills have been scarcely studied but appear to be effective in NCCP patients.
  
  
  CONCLUSIONS
  Medical, endoscopic and surgical therapeutic options are available for the treating physician, although some patients with non-cardiac chest pain may require a multimodal therapeutic approach.
authors.affiliation: Division of Gastroenterology and Hepatology, The Esophageal and Swallowing Center, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: N
authors.initials: N
authors.lastname: George
authors.affiliation: Division of Gastroenterology and Hepatology, The Esophageal and Swallowing Center, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: J
authors.initials: J
authors.lastname: Abdallah
authors.affiliation: Division of Gastroenterology and Hepatology, The Esophageal and Swallowing Center, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: C
authors.initials: C
authors.lastname: Maradey-Romero
authors.affiliation: Division of Gastroenterology, California Pacific Medical Center, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: L
authors.initials: L
authors.lastname: Gerson
authors.affiliation: Division of Gastroenterology and Hepatology, The Esophageal and Swallowing Center, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: R
authors.initials: R
authors.lastname: Fass
mesh_terms: D002637:Chest Pain / Q000209:etiology*; D015154:Esophageal Motility Disorders / Q000150:complications / Q000628:therapy*; D005764:Gastroesophageal Reflux / Q000150:complications / Q000628:therapy*; D006801:Humans