Functional Chest Pain

Mudipalli, Ranjit; Troche, José María Remes; Andersen, Leslie; Rao, Satish S.

doi:10.1097/01.mcg.0000225521.36160.1b

Cited by 32 publications

(6 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Sildenafil, a phosphodiesterase-5 inhibitor was examined in an uncontrolled small study of patients with spastic esophageal motor disorders (42), and the results were inconsistent; acid reflux, and cardiac disease were not excluded. Sildenafil – Open label study, not randomized (40) with quality score of 0 (tables 2a & 2b).…”

Section: Resultsmentioning

confidence: 99%

“…Esophageal hypersensitivity is a key neurobiological mechanism that causes pain (41,42). Patients with ECP demonstrated 50% lower sensory thresholds when compared to controls together with a hyperreactive and poorly compliant esophagus (43).…”

Section: Resultsmentioning

confidence: 99%

“…If ineffective, or patient has overlapping features of irritable bowel syndrome, functional dyspepsia or anxiety (42), a trial of low dose anti-depressants, such as imipramine, sertraline or venlafaxine may be considered (49,51–53,56). If none of these approaches help, a psychology consultation together cognitive behavioral therapy or hypnotherapy (62–66) should be considered.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Treatment of Esophageal (Noncardiac) Chest Pain: An Expert Review

Coss‐Adame

Erdoğan

Rao

2014

Clinical Gastroenterology and Hepatology

View full text Add to dashboard Cite

Objectives Chest pain is a common and frightening symptom. Once cardiac disease has been excluded, an esophageal source is most likely. Pathophysiologically, gastroesophageal reflux disease (GERD), esophageal dysmotility, esophageal hypersensitivity and anxiety disorders have been implicated. Treatment however remains a challenge. Here, we examined the efficacy and safety of various commonly used modalities for treatment of esophageal (non-cardiac) chest pain (ECP) and provided evidence-based recommendations. Methods We reviewed the English literature for drug trials evaluating treatment of ECP in PUBMED, COCHRANE and MEDLINE databases from 1968 to 2012. Standard forms were used to abstract data regarding study design, duration, outcome measures and adverse events and study quality. Results Thirty five studies comprising of various treatments were included and grouped under five broad catagories. Patient inclusion criteria were extremely variable and studies were generally small with methodological concerns. There was good evidence to support the use of omeprazole, and fair evidence for lansoprazole, rabeprazole, theophylline, sertraline, trazodone, venlafaxine, imipramine and cognitive behavioral therapy (CBT). There was poor evidence for nifedipine, diltiazem, paroxetine, biofeedback therapy, ranitidine, nitrates, botulinum toxin, esophageal myotomy and hypnotherapy. Conclusions Ideally, treatment of ECP should be aimed at correcting the underlying mechanism(s) and relieving symptoms. PPIs, antidepressants, theophylline and CBT appear to be useful for the treatment of ECP. However, there is urgent and unmet need for effective treatments and for rigorous, randomized controlled trials.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Treatment of Esophageal (Noncardiac) Chest Pain: An Expert Review

Coss‐Adame

Erdoğan

Rao

2014

Clinical Gastroenterology and Hepatology

View full text Add to dashboard Cite

show abstract

“…There is a significant overlap of IBS with other symptomatic GI disorders such as gastroesophageal reflux disease, dyspepsia, and normal-transit constipation. 20 No universal pathophysiologic mechanism has been demonstrated in IBS, but visceral hypersensitivity is generally accepted as a key underlying mechanism. 2 , 21 IBS symptoms also tend to follow some commonly observed patterns; symptoms may be episodic and are often associated with food intake and/or defecation.…”

Section: Irritable Bowel Syndromementioning

confidence: 99%

“… 2 , 21 IBS symptoms also tend to follow some commonly observed patterns; symptoms may be episodic and are often associated with food intake and/or defecation. 2 , 17 , 20 These symptoms may be of sufficient severity to interfere with their daily life and social functioning. 2 Many patients may have developed IBS as a consequence of a previous intestinal infection 22 or major life event/stressor, such as an abdominal/pelvic trauma or surgery.…”

Section: Irritable Bowel Syndromementioning

confidence: 99%

Clinical Evaluation of a Patient With Symptoms of Colonic or Anorectal Motility Disorders

Curtin

Jimenez

Rao

2020

J Neurogastroenterol Motil

View full text Add to dashboard Cite

Constipation, irritable bowel syndrome, fecal incontinence, abdominal pain, and anorectal pain are problems that affect 40% of the population. They commonly present with overlapping symptoms indicating that their pathophysiology affects multiple segments of the gut as well as brain and gut interactions. Clinically, although some conditions are readily recognized, dyssynergic defecation, fecal incontinence, and anorectal pain are often missed or misdiagnosed. Consequently, the assessment of lower gastrointestinal symptoms in patients with suspected colonic or anorectal motility disorder(s) remains challenging for most clinicians. A detailed history, use of the Bristol stool form scale, prospective stool diaries, ideally through a phone App, digital rectal examination, and judicious use of complementary diagnostic tests are essential. Additionally, it is important to evaluate the impact of these problems on quality of life and psychosocial issues, because they are intricately linked with these disorders. The Rome IV diagnostic questionnaire for functional gastrointestinal disorders can provide additional information often missed during history taking. Here, we discuss a systematic approach for the clinical evaluation of patients with suspected lower gastrointestinal problems, grouped under 4 common diagnostic categories. We describe how to take a detailed history, perform meticulous digital rectal examination, and use validated tools to supplement clinical evaluation, including assessments of quality of life and scoring systems for disease severity and digital Apps. These tools could facilitate a comprehensive plan for clinical management including diagnostic tests, and translate the patients' complaints into definable, diagnostic categories.

show abstract