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

Enrique Coss-Adame, Askin Erdogan, Satish S.C. Rao

Research output: Contribution to journalArticlepeer-review

22 Scopus citations


Background & Aims: Chest pain is a common and frightening symptom. Once cardiac disease has been excluded, an esophageal source is most likely. Pathophysiologically, gastroesophageal reflux disease, esophageal dysmotility, esophageal hypersensitivity, and anxiety disorders have been implicated. However, treatment remains a challenge. Here we examined the efficacy and safety of various commonly used modalities for treatment of esophageal (noncardiac) chest pain (ECP) and provided evidence-based recommendations. Methods: We reviewed the English language literature for drug trials evaluating treatment of ECP in PubMed, Cochrane, and MEDLINE databases from 1968-2012. Standard forms were used to abstract data regarding study design, duration, outcome measures and adverse events, and study quality. Results: Thirty-five studies comprising various treatments were included and grouped under 5 broad categories. 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. 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. Proton pump inhibitors, antidepressants, theophylline, and cognitive behavioral therapy 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.

Original languageEnglish (US)
Pages (from-to)1224-1245
Number of pages22
JournalClinical Gastroenterology and Hepatology
Issue number8
StatePublished - Aug 2014


  • Behavioral Therapy
  • Esophageal Chest Pain
  • GERD
  • Hypersensitivity
  • Noncardiac Chest Pain Treatment

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology


Dive into the research topics of 'Treatment of Esophageal (Noncardiac) Chest Pain: An Expert Review'. Together they form a unique fingerprint.

Cite this