J Neurogastroenterol Motil.
2024 Jul;30(3):272-280. 10.5056/jnm23166.
The Role of Psychological Factors in Noncardiac Chest Pain of Esophageal Origin
- Affiliations
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- 1Cleveland Clinic, Critical Care Medicine Department, Cleveland, OH, USA
- 2Department of Research, Sinaloa Health Services, Women’s Hospital, Sinaloa, Mexico
- 3Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
- 4Digestive Health Center, Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Cleveland, OH, USA
- KMID: 2557964
- DOI: http://doi.org/10.5056/jnm23166
Abstract
- Background/Aims
Noncardiac chest pain (NCCP) of esophageal origin is a challenging clinical problem of diverse etiology that affects more than 80 million Americans yearly. We assess the prevalence and impact of psychological disorders on NCCP of esophageal origin, describe possible mechanisms associated with this condition, and review psychological therapy options.
Methods
Online search using PubMed and Medline from January 1, 1966, to April 30, 2023.
Results
Psychological disorders have been reported in up to 79% of patients with NCCP of esophageal origin. Several psychological disturbances have been identified with this condition, including depression, anxiety, panic disorder, phobias, and obsessivecompulsive and somatoform disorders. It is unclear whether the psychological disorders trigger the chest pain or vice versa. Multiple psychological mechanisms have been linked to chest pain and may contribute to its pathogenesis and severity. These mechanisms include cardiophobia, poor coping strategies, negative social problem solving, stress and perceived control, hypervigilance to cardiopulmonary sensations, altered pain perception, and alexithymia. Psychological therapies for NCCP of esophageal origin include cognitive behavioral therapy, hypnotherapy, physical and relaxation training, breathing retraining, and alternative medicine. Among the therapeutic options, cognitive behavioral therapy has been shown to be an effective treatment for NCCP of esophageal origin.
Conclusion
This review raises awareness about the high prevalence of psychological disorders in NCCP of esophageal origin and highlights the need for clinical trials and trained therapists to address the management of this taxing clinical problem.
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