Korean J Gastroenterol.  2010 Apr;55(4):217-224. 10.4166/kjg.2010.55.4.217.

Diagnosis and Management of Esophageal Chest Pain

• Hong SJ

• KMID: 1792771
• DOI: http://doi.org/10.4166/kjg.2010.55.4.217

Abstract

Esophageal pain that manifests as heartburn or chest pain, is a prevalent problem. Esophageal chest pain is most often caused by gastroesophageal reflux disease (GERD), but can also result from inflammatory processes, infections involving the esophagus, and contractions of the esophageal muscle. The mechanisms and pathways of esophageal chest pain are poorly understood. Vagal and spinal afferent pathways carry sensory information from the esophagus. Recently, esophageal hypersensitivity is identified as an important factor in the development of esophageal pain. A number of techniques are available to evaluate esophageal chest pain such as endoscopy and/or proton-pump inhibitor trial, esophageal manometry, a combined impedance-pH study, and esophageal ultrasound imaging. Proton pump inhibitors (PPIs) have the huge success in the treatment of GERD. Other drugs such as imipramine, trazadone, sertraline, tricyclics, and theophylline have been introduced for the control of esophageal chest pain in partial responders to PPI and the patients with esophageal hypersensitivity. Novel drugs which act on different targets are anticipated to treat esophageal pain in the future.

Keyword

Esophagus; Chest pain

MeSH Terms

Chest Pain/*etiology
Esophageal pH Monitoring
Gastroesophageal Reflux/*diagnosis/drug therapy/ultrasonography
Humans
Manometry
Proton Pump Inhibitors/therapeutic use

Figure

• 

  Fig. 1. Diagnostic and treatment strategy of esophageal chest pain. GERD, gastroesophageal reflux disease; TLESR, transient lower esophageal sphincter relaxation.

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