C. Shekhar; P. J. Whorwell

Name: Evaluation and Management of Patients with Noncardiac Chest Pain
Author: C. Shekhar; P. J. Whorwell

Evaluation and Management of Patients with Noncardiac Chest Pain

Summary

“Evaluation and Management of Patients with Noncardiac Chest Pain”, is a work by C. Shekhar; P. J. Whorwell. It explores elements such as esophagus, motility and panic disorder.

Quotes from Evaluation and Management of Patients with Noncardiac Chest Pain (C. Shekhar; P. J. Whorwell)

C. Shekhar; P. J. Whorwell, Evaluation and Management of Patients with Noncardiac Chest Pain

“ If the patient responds, then GERD-related chest pain is the most likely diagnosis and maintenance treatment may be required. Failure to respond to a PPI suggests that acid reflux is not the problem although obviously this does not exclude nonacid reflux. In the absence of reflux, it is usually assumed that the problem may be due to a disorder of motility or sensation. On the assumption that esophageal contractions may be contributing to the pain, a variety of treatments aiming at relieving spasm have been evaluated. ”

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C. Shekhar; P. J. Whorwell, Evaluation and Management of Patients with Noncardiac Chest Pain

“ Abstract Up to a third of patients undergoing coronary angiography for angina-like chest pain are found to have normal coronary arteries and a substantial proportion of these individuals continue to consult and even attend emergency departments. Initially, these patients are usually seen by cardiologists but with accumulating evidence that the pain might have a gastrointestinal origin, it may be more appropriate for them to be cared for by the gastroenterologist once a cardiological cause has been excluded. ”

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C. Shekhar; P. J. Whorwell, Evaluation and Management of Patients with Noncardiac Chest Pain

“ However, if patients can be trusted to take them on an “as necessary basis” when the pain is especially severe, we find that they have a role in NCCP and other functional gastrointestinal disorders, as long as they are used with caution. There has been recent interest in the possibility that theophylline might have a role in the treatment of NCCP [37] , especially as it appears to increase the threshold to balloon distension-induced pain in the esophagus. In the one trial so far reported, the drug appeared to significantly relieve symptoms in a relatively small group of patients [38] . ”

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C. Shekhar; P. J. Whorwell, Evaluation and Management of Patients with Noncardiac Chest Pain

“ There is evidence that selective serotonin reuptake inhibition can reduce chemical and mechanical sensitivity of the esophagus [29] although there has only been one study assessing the effect of this class of drug in NCCP, but this was encouraging [30] . Benzodiazepines have also been shown to possibly be beneficial [31] [32] . This is probably because of their anxiolytic properties as patients with NCCP have been shown to be prone to panic disorder [33] [34] [35] [36] . Unfortunately, this group of drugs is out of favor at present because of their addictive potential. ”

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C. Shekhar; P. J. Whorwell, Evaluation and Management of Patients with Noncardiac Chest Pain

“ It is important that cardiac disease is excluded at least by an exercise stress test and, in many cases, it may be necessary to undertake an angiogram. The latter is especially useful in refractory cases so that physicians can be secure about their reassurance as well as being confident in their therapeutic approach. ”

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C. Shekhar; P. J. Whorwell, Evaluation and Management of Patients with Noncardiac Chest Pain

“ Baunack, A. R. & Ramsch, K.-D. (1991) , Effect of the calcium antagonists nifedipine, nitrendipine, nimodipine and nisoldipine on oesophageal motility in man, vol. 41, pp. 313–316, DOI 10.1007/BF00314958 ↑ Richter, J. E.; Dalton, C. B.; Bradley, L. A. & Castell, D. O. (1987) , Oral nifedipine in the treatment of noncardiac chest pain in patients with the nutcracker esophagus, vol. 93, pp. 21–28 ↑ Richter, J. E.; Dalton, C. B.; Buice, R. G. & Castell, D. O. (1985) , Nifedipine: a potent inhibitor of contractions in the body of the human esophagus. ”

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C. Shekhar; P. J. Whorwell, Evaluation and Management of Patients with Noncardiac Chest Pain

“ Studies in healthy volunteers and patients with the nutcracker esophagus, vol. 89, pp. 549–554 ↑ Jackson, J. L.; O'Malley, P. G.; Tomkins, G.; Balden, E.; Santoro, J. & Kroenke, K. (2000) , Treatment of functional gastrointestinal disorders with antidepressant medications: a meta-analysis, vol. 108, pp. 65–72, DOI 10.1016/S0002-9343 (99) 00299-5 ↑ http://www.nice.org.uk/Guidance/CG61↑ Cannon, R. O.; Quyyumi, A. A. & Mincemoyer, R. (1994) , Imipramine in patients with chest pain despite normal coronary angiograms, vol. ”

C. Shekhar; P. J. Whorwell

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