There is growing evidence about the value of psychological intervention in patients with NCCP in the form of cognitive behavioral therapy or hypnotherapy. Noncardiac chest pain (NCCP) affects approximately 1 quarter of the adult population in the United States. The pathophysiology of the disorder remains to be fully elucidated. Identified underlying mechanisms for esophageal pain include gastroesophageal reflux disease (GERD), esophageal dysmotility, and visceral hypersensitivity.
The side effect profiles vary with each drug and there is potential for drug interactions especially in the setting of polypharmacy among palliative care patients. The prevalence of non-cardiac chest pain in general population has been estimated as 13%. Non-cardiac chest pain might be caused by either acid reflux, esophageal motility disorders, eosinophilic esophagitis or visceral hypersensitivity (functional chest pain). After a cardiac cause of chest pain has been excluded, a short-term trial with proton pomp inhibitor (PPI) is the most cost-effective method for assessing whether non-cardiac chest pain is due to acid reflux. Upper endoscopy with biopsies of the esophagus are recommended to exclude erosive or eosinophilic esophagitis as possible causes of chest pain.
From 400 screened patients with chest pain and heartburn, 54 (age 44.5 Â± 8.8 years and 74% females) had abnormal manometry and underwent acid exposure measurement. Frequencies of the EH disorder were classic NE (EH(3 cm)) found in 29 (40.8%) patients, diffuse (EH(3,8 cm)) in 30 patients (42.3%), and upper segmental (EH(8 cm)) in 12 patients (16.9%).  . Although treatment of NCCP is difficult because of its variety of sources and expressions, GERDrelated NCCP responds to a high dose of proton-pump inhibitor, which is an effective way to confirm actually, if not make, the GERD diagnosis .
Heartburn is the cardinal symptom of gastroesophageal reflux disease (GERD). GERD is a common condition with a prevalence of 10-30% in Western Europe and North America. GERD is commonly diagnosed based on symptoms without diagnostic testing. Symptom response to anti-reflux treatment is used to further cement the diagnosis of GERD prior to entertaining any invasive testing. Tools that are currently available for diagnosing GERD include the PPI test, barium esophagram, upper endoscopy, esophageal pH monitoring, and multichannel intraluminal impedance with pH sensor (MII-pH).Noncardiac chest pain (NCCP) affects approximately one quarter of the adult population in the United States.
Fig. 2 provides a flow chart for treatment and diagnosis of NCCP. hydrogen-potassium ATPase proton pump located on the luminal side of the gastric parietal cell. Proton pump inhibitors are mostly indicated in the treatment of chemotherapy induced gastroesophageal reflux disease (GERD), in addition, they are first line agents for the treatment of dyspepsia, Helicobacter Pylori eradication, and the prevention and treatment of NSAID and glucocorticosteroid-induced ulcers. There is evidence to support the use of PPIs for treatment of hemoptysis and to limit the incidence of rebleeding palliative patients with peptic ulceration, for metastatic esophageal and gastric carcinoma.
Chest wall syndromes are common but probably often missed. Many patients with NCCP have psychologic or psychiatric abnormalities, as either the cause or an effect of the chest pain, but diagnosis here depends on techniques not applied easily in the acute situation. Pain modulators seem to offer significant improvement in chest pain symptoms for non-GERD-related NCCP. Finally, trials of management strategies to deal with this nagging problem are required urgently, . because the earlier discharge of patients with NCCP may exacerbate the nagging problem..
Characteristics of postradical neck pain syndrome: a report of 25 cases
Firstly, because acute chest pain is a symptom of a paucity of diseases, which makes diagnosis difficult and time consuming, while there is also a time constraint, due to the extreme suffering of the patient. Secondly, the condition of a patient with advanced cancer disease and co-morbidities does not always allow for required diagnostic procedures. The present report describes a full case of acute, severe epigastric/chest pain in a patient with dynamic disease progression, who was receiving palliative care.
I go over a number of strategies you can apply to reduce a hiatal hernia in this article. Gastroesophageal reflux disease (GERD) is almost completely preventable, if you make the right lifestyle changes. Learn how to fend off GERD. Patients with chest pain and normal coronary angiograms, patients with chest pain and coronarographically diagnosed coronary artery controls and disease were prospectively studied with long-term manometry.
Chest pain of esophageal origin or noncardiac chest pain is reported by at least a fifth of the general population. Recent literature focused on further understanding mechanisms of chest pain in subset of patients with functional chest pain of presumed esophageal origin. Studies have demonstrated concurrent somatic and visceral pain hypersensitivity, and amplified secondary allodynia, in patients with noncardiac chest pain (NCCP), suggesting central sensitization. Other studies have demonstrated abnormal cerebral processing of intraesophageal stimuli.
Identified underlying mechanisms for esophageal pain include gastroesophageal reflux disease (GERD), esophageal dysmotility, and esophageal hypersensitivity. Patient’s history and symptom characteristics do not reliably distinguish between cardiac and esophageal causes of chest pain. All patients presenting with chest pain should be evaluated first by a cardiologist to rule out a cardiac cause. Non-gastrointestinal causes should be screened by the primary care physician to referral to a gastroenterologist prior.