J Neurogastroenterol Motil.  2019 Oct;25(4):487-498. 10.5056/jnm19146.

Diagnosis and Management of Functional Chest Pain in the Rome IV Era

Affiliations
  • 1The Esophageal and Swallowing Center, MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH, USA. ronnie.fass@gmail.com
  • 2Departamento de Trastornos Funcionales Digestivos, Gedyt-Gastroenterología Diagnóstica y Terapéutica, BuenosAires, Argentina.

Abstract

Functional chest pain accounts for about a third of the patients with noncardiac chest pain. It is a very common functional esophageal disorder that remains even today a management challenge to the practicing physician. Based on the definition offered by the Rome IV criteria, diagnosis of functional chest pain requires a negative workup of noncardiac chest pain patients that includes, proton pump inhibitor test or empirical proton pump inhibitor trial, endoscopy with esophageal mucosal biopsies, reflux testing, and esophageal manometry. The mainstay of treatment are neuromodulators that are primarily composed of anti-depressants. Alternative medicine and psychological interventions may be provided alone or in combination with other therapeutic modalities.

Keyword

Alternative medicine; Chest pain; Endoscopy; Neuromodulators; Proton pump inhibitors

MeSH Terms

Biopsy
Chest Pain*
Complementary Therapies
Diagnosis*
Endoscopy
Humans
Manometry
Neurotransmitter Agents
Proton Pump Inhibitors
Proton Pumps
Thorax*
Neurotransmitter Agents
Proton Pump Inhibitors
Proton Pumps
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