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Gastroenterology > Non-cardiac Chest Pain > Flashcards

Non-cardiac Chest Pain Flashcards

1
Q

What is the most common contributing factor to non-cardiac chest pain (NCCP)?

A

GERD

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2
Q

What are the two main contributing mechanisms to non-GERD-related NCCP?

A

Esophageal motility disorders

Functional chest pain of presumed esophageal origin

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3
Q

What are the Rome III criteria for functional chest pain of presumed esophageal origin (4 criteria)?

A
  1. Midline chest pain/discomfort that is not burning
  2. GERD ruled out
  3. Bx ruled out esophageal motility disorder
  4. All criteria fulfilled for last 3 months with symptom onset at least 6 months before diagnosis
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4
Q

What percentage of patients with functional chest pain have other functional disorders, such as IBD and abdominal bloating?

A

20%

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5
Q

Can History and Physical Exam reliably distinguish between cardiac and esophageal causes of chest pain?

A

No

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6
Q

What percentage of patients with chest pain have normal coronary angiography?

A

30%

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7
Q

What percentage of patients with atypical chest pain have coronary artery disease?

A

25%

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8
Q

What percentage of patients with non-GERD-related NCCP have normal esophageal motility?

A

Over 70%

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9
Q

What are alarm signs and symptoms in NCCP (4)?

A
  1. Weight loss
  2. Dysphagia
  3. Upper GI bleeding
  4. Anemia
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10
Q

What are common diagnostic tests used in evaluating NCCP? (4)

A
  1. PPI test
  2. EGD
  3. Esophageal pH monitoring
  4. Esophageal manometry
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11
Q

What is the purpose of the PPI test in NCCP?

A

Diagnosing if the NCCP is GERD-related

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12
Q

In NCCP patients with alarm features, what should the initial test be?

A

EGD

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13
Q

When is esophageal manometry indicated in NCCP?

A

After GERD has been excluded to see if esophageal motility is abnormal

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14
Q

What are the more commonly seen esophageal motility abnormalities seen in NCCP?

A
  1. Hypotensive LES
  2. Hypertensive LES
  3. Non-specific esophageal motor disorder
  4. Nutcracker esophagus
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15
Q

What is the treatment for GERD-related NCCP?

A

PPI twice daily for at least 2 months,

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16
Q

What is the main goal of the eating non-GERD-related NCCP?

A

Esophageal pain modulation

17
Q

Which drugs are used to modulate esophageal pain in non-GERD-related NCCP? (3)

A
  1. TCAs
  2. SSRIs
  3. Trazodone

Given in non-mood altering low dose, at bedtime

18
Q

Prior to GI evaluation, who should evaluate a patient presenting with chest pain?

A

Cardiologist

19
Q

What is the most common cause of NCCP?

A

GERD

20
Q

In patients refractory to treatment for NCCP, referral to which specialty should be considered?

A

Psychologist/psychiatrist specializing in functional bowel disorders

21
Q

What is the definition of non-cardiac chest pain (NCCP)?

A

Recurrent angina-like retro sterna chest pain of non-cardiac origin

Gastroenterology (5 decks)

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