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Current and future treatment of chest pain of presumed esophageal origin.

Abstract
Patients with chest pain of presumed esophageal origin should be reassured and should undergo an esophageal manometry study. In patients with spastic esophageal disorders, a trial with calcium channel blockers or low-dose antidepressants used as visceral analgesics is the best approach. Inpatients with non GERD-related, nonspastic esophageal motility disorder, low-dose antidepressants seem reasonable. Anxiolytics are useful in patients with panic disorders, and psychological interventions (eg, cognitive-behavioral therapy) are also valuable, mainly in patients in whom reassurance is not sufficient to avoid the misinterpretation of their symptoms. In the future, visceral sensitivity modifying agents such as serotoninergic agonists or antagonists may become the cornerstone of therapy in patients with chest pain of presumed esophageal origin. Combinations of different approaches, such as proton pump inhibitors and psychotropic or antinociceptive agents, should also be evaluated in clinical trials.
AuthorsMax J Schmulson, Miguel Angel Valdovinos
JournalGastroenterology clinics of North America (Gastroenterol Clin North Am) Vol. 33 Issue 1 Pg. 93-105 (Mar 2004) ISSN: 0889-8553 [Print] United States
PMID15062440 (Publication Type: Journal Article, Review)
Chemical References
  • Cholinergic Antagonists
  • Muscle Relaxants, Central
  • Neuromuscular Agents
  • Psychotropic Drugs
  • Botulinum Toxins, Type A
Topics
  • Behavior Therapy
  • Botulinum Toxins, Type A (therapeutic use)
  • Chest Pain (etiology, physiopathology, psychology, therapy)
  • Cholinergic Antagonists (therapeutic use)
  • Esophagus (physiopathology)
  • Gastroesophageal Reflux (complications)
  • Humans
  • Muscle Relaxants, Central (therapeutic use)
  • Neuromuscular Agents (therapeutic use)
  • Psychotropic Drugs (therapeutic use)

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