The Mexican consensus on non-cardiac chest pain
Non-cardiac chest pain is defined as a clinical syndrome characterized by retrosternal pain similar to that of angina pectoris, but of non-cardiac origin and produced by esophageal, musculoskeletal, pulmonary, or psychiatric diseases. Aim: To present a consensus review based on evidence regarding th...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Asociación Mexicana de Gastroenterología
2019
|
| Subjects: | |
| Online Access: | http://eprints.uanl.mx/20145/1/1-s2.0-S2255534X19300684-main.pdf |
| _version_ | 1824415763644022784 |
|---|---|
| author | Gómez Escudero, O. Coss Adame, E. Amieva Balmori, M. Carmona Sánchez, R.I. Remes Troche, José M. Abreu Abreu, A.T. Cerda Contreras, E. Gómez Castaños, P.C. González Martínez, M.A. Huerta Iga, F.M. Ibarra Palomino, J. Icaza Chávez, M. E. Lopéz Colombo, A. Márquez Murillo, M.F. Mejía Rivas, M. Morales Arámbula, M. Rodríguez Chávez, José Luis Torres Barrera, G. Valdovinos García, L.R. Valdovinos Díaz, M. A. Vázquez Elizondo, Genaro Villar Chávez, A.S. Zavala Solares, M. Achem, S.R. |
| author_facet | Gómez Escudero, O. Coss Adame, E. Amieva Balmori, M. Carmona Sánchez, R.I. Remes Troche, José M. Abreu Abreu, A.T. Cerda Contreras, E. Gómez Castaños, P.C. González Martínez, M.A. Huerta Iga, F.M. Ibarra Palomino, J. Icaza Chávez, M. E. Lopéz Colombo, A. Márquez Murillo, M.F. Mejía Rivas, M. Morales Arámbula, M. Rodríguez Chávez, José Luis Torres Barrera, G. Valdovinos García, L.R. Valdovinos Díaz, M. A. Vázquez Elizondo, Genaro Villar Chávez, A.S. Zavala Solares, M. Achem, S.R. |
| author_sort | Gómez Escudero, O. |
| collection | Repositorio Institucional |
| description | Non-cardiac chest pain is defined as a clinical syndrome characterized by retrosternal pain similar to that of angina pectoris, but of non-cardiac origin and produced by esophageal, musculoskeletal, pulmonary, or psychiatric diseases. Aim: To present a consensus review based on evidence regarding the definition, epidemiology,pathophysiology, and diagnosis of non-cardiac chest pain, as well as the therapeutic options for those patients. Methods Three general coordinators carried out a literature review of all articles published in english and spanish on the theme and formulated 38 initial statements, dividing them into 3 main categories: 1) definitions, epidemiology, and pathophysiology, 2) diagnosis, and 3) treatment.The statements underwent 3 rounds of voting, utilizing the Delphi system. The final statements were those that reached > 75% agreement, and they were rated utilizing the GRADE system. Results and conclusions The final consensus included 29 statements. All patients presenting with chest pain should initially be evaluated by a cardiologist. The most common cause of non-cardiac chest pain is gastroesophageal reflux disease. If there are no alarm symptoms, the initial approach should be a therapeutic trial with a proton pump inhibitor for 2-4 weeks. If dysphagia or alarm symptoms are present, endoscopy is recommended. High-resolution manometry is the best method for ruling out spastic motor disorders and achalasia and pH monitoring aids in demonstrating abnormal esophageal acid exposure. Treatment should be directed at the pathophysiologic mechanism. It can include proton pump inhibitors, neuromodulators and/or smooth muscle relaxants, psychologic intervention and/or cognitive therapy, and occasionally surgery or endoscopic therapy. |
| format | Article |
| id | eprints-20145 |
| institution | UANL |
| language | English |
| publishDate | 2019 |
| publisher | Asociación Mexicana de Gastroenterología |
| record_format | eprints |
| spelling | eprints-201452024-02-16T16:09:04Z http://eprints.uanl.mx/20145/ The Mexican consensus on non-cardiac chest pain Gómez Escudero, O. Coss Adame, E. Amieva Balmori, M. Carmona Sánchez, R.I. Remes Troche, José M. Abreu Abreu, A.T. Cerda Contreras, E. Gómez Castaños, P.C. González Martínez, M.A. Huerta Iga, F.M. Ibarra Palomino, J. Icaza Chávez, M. E. Lopéz Colombo, A. Márquez Murillo, M.F. Mejía Rivas, M. Morales Arámbula, M. Rodríguez Chávez, José Luis Torres Barrera, G. Valdovinos García, L.R. Valdovinos Díaz, M. A. Vázquez Elizondo, Genaro Villar Chávez, A.S. Zavala Solares, M. Achem, S.R. RC Medicina Interna, Psiquiatría, Neurología Non-cardiac chest pain is defined as a clinical syndrome characterized by retrosternal pain similar to that of angina pectoris, but of non-cardiac origin and produced by esophageal, musculoskeletal, pulmonary, or psychiatric diseases. Aim: To present a consensus review based on evidence regarding the definition, epidemiology,pathophysiology, and diagnosis of non-cardiac chest pain, as well as the therapeutic options for those patients. Methods Three general coordinators carried out a literature review of all articles published in english and spanish on the theme and formulated 38 initial statements, dividing them into 3 main categories: 1) definitions, epidemiology, and pathophysiology, 2) diagnosis, and 3) treatment.The statements underwent 3 rounds of voting, utilizing the Delphi system. The final statements were those that reached > 75% agreement, and they were rated utilizing the GRADE system. Results and conclusions The final consensus included 29 statements. All patients presenting with chest pain should initially be evaluated by a cardiologist. The most common cause of non-cardiac chest pain is gastroesophageal reflux disease. If there are no alarm symptoms, the initial approach should be a therapeutic trial with a proton pump inhibitor for 2-4 weeks. If dysphagia or alarm symptoms are present, endoscopy is recommended. High-resolution manometry is the best method for ruling out spastic motor disorders and achalasia and pH monitoring aids in demonstrating abnormal esophageal acid exposure. Treatment should be directed at the pathophysiologic mechanism. It can include proton pump inhibitors, neuromodulators and/or smooth muscle relaxants, psychologic intervention and/or cognitive therapy, and occasionally surgery or endoscopic therapy. Asociación Mexicana de Gastroenterología 2019 Article PeerReviewed text en cc_by_nc_nd http://eprints.uanl.mx/20145/1/1-s2.0-S2255534X19300684-main.pdf http://eprints.uanl.mx/20145/1.haspreviewThumbnailVersion/1-s2.0-S2255534X19300684-main.pdf Gómez Escudero, O. y Coss Adame, E. y Amieva Balmori, M. y Carmona Sánchez, R.I. y Remes Troche, José M. y Abreu Abreu, A.T. y Cerda Contreras, E. y Gómez Castaños, P.C. y González Martínez, M.A. y Huerta Iga, F.M. y Ibarra Palomino, J. y Icaza Chávez, M. E. y Lopéz Colombo, A. y Márquez Murillo, M.F. y Mejía Rivas, M. y Morales Arámbula, M. y Rodríguez Chávez, José Luis y Torres Barrera, G. y Valdovinos García, L.R. y Valdovinos Díaz, M. A. y Vázquez Elizondo, Genaro y Villar Chávez, A.S. y Zavala Solares, M. y Achem, S.R. (2019) The Mexican consensus on non-cardiac chest pain. Revista de Gastroenterología de México (English Edition), 84 (3). pp. 372-397. ISSN 2255-534X http://doi.org/10.1016/j.rgmxen.2019.07.001 doi:10.1016/j.rgmxen.2019.07.001 |
| spellingShingle | RC Medicina Interna, Psiquiatría, Neurología Gómez Escudero, O. Coss Adame, E. Amieva Balmori, M. Carmona Sánchez, R.I. Remes Troche, José M. Abreu Abreu, A.T. Cerda Contreras, E. Gómez Castaños, P.C. González Martínez, M.A. Huerta Iga, F.M. Ibarra Palomino, J. Icaza Chávez, M. E. Lopéz Colombo, A. Márquez Murillo, M.F. Mejía Rivas, M. Morales Arámbula, M. Rodríguez Chávez, José Luis Torres Barrera, G. Valdovinos García, L.R. Valdovinos Díaz, M. A. Vázquez Elizondo, Genaro Villar Chávez, A.S. Zavala Solares, M. Achem, S.R. The Mexican consensus on non-cardiac chest pain |
| thumbnail | https://rediab.uanl.mx/themes/sandal5/images/online.png |
| title | The Mexican consensus on non-cardiac chest pain |
| title_full | The Mexican consensus on non-cardiac chest pain |
| title_fullStr | The Mexican consensus on non-cardiac chest pain |
| title_full_unstemmed | The Mexican consensus on non-cardiac chest pain |
| title_short | The Mexican consensus on non-cardiac chest pain |
| title_sort | mexican consensus on non cardiac chest pain |
| topic | RC Medicina Interna, Psiquiatría, Neurología |
| url | http://eprints.uanl.mx/20145/1/1-s2.0-S2255534X19300684-main.pdf |
| work_keys_str_mv | AT gomezescuderoo themexicanconsensusonnoncardiacchestpain AT cossadamee themexicanconsensusonnoncardiacchestpain AT amievabalmorim themexicanconsensusonnoncardiacchestpain AT carmonasanchezri themexicanconsensusonnoncardiacchestpain AT remestrochejosem themexicanconsensusonnoncardiacchestpain AT abreuabreuat themexicanconsensusonnoncardiacchestpain AT cerdacontrerase themexicanconsensusonnoncardiacchestpain AT gomezcastanospc themexicanconsensusonnoncardiacchestpain AT gonzalezmartinezma themexicanconsensusonnoncardiacchestpain AT huertaigafm themexicanconsensusonnoncardiacchestpain AT ibarrapalominoj themexicanconsensusonnoncardiacchestpain AT icazachavezme themexicanconsensusonnoncardiacchestpain AT lopezcolomboa themexicanconsensusonnoncardiacchestpain AT marquezmurillomf themexicanconsensusonnoncardiacchestpain AT mejiarivasm themexicanconsensusonnoncardiacchestpain AT moralesarambulam themexicanconsensusonnoncardiacchestpain AT rodriguezchavezjoseluis themexicanconsensusonnoncardiacchestpain AT torresbarrerag themexicanconsensusonnoncardiacchestpain AT valdovinosgarcialr themexicanconsensusonnoncardiacchestpain AT valdovinosdiazma themexicanconsensusonnoncardiacchestpain AT vazquezelizondogenaro themexicanconsensusonnoncardiacchestpain AT villarchavezas themexicanconsensusonnoncardiacchestpain AT zavalasolaresm themexicanconsensusonnoncardiacchestpain AT achemsr themexicanconsensusonnoncardiacchestpain AT gomezescuderoo mexicanconsensusonnoncardiacchestpain AT cossadamee mexicanconsensusonnoncardiacchestpain AT amievabalmorim mexicanconsensusonnoncardiacchestpain AT carmonasanchezri mexicanconsensusonnoncardiacchestpain AT remestrochejosem mexicanconsensusonnoncardiacchestpain AT abreuabreuat mexicanconsensusonnoncardiacchestpain AT cerdacontrerase mexicanconsensusonnoncardiacchestpain AT gomezcastanospc mexicanconsensusonnoncardiacchestpain AT gonzalezmartinezma mexicanconsensusonnoncardiacchestpain AT huertaigafm mexicanconsensusonnoncardiacchestpain AT ibarrapalominoj mexicanconsensusonnoncardiacchestpain AT icazachavezme mexicanconsensusonnoncardiacchestpain AT lopezcolomboa mexicanconsensusonnoncardiacchestpain AT marquezmurillomf mexicanconsensusonnoncardiacchestpain AT mejiarivasm mexicanconsensusonnoncardiacchestpain AT moralesarambulam mexicanconsensusonnoncardiacchestpain AT rodriguezchavezjoseluis mexicanconsensusonnoncardiacchestpain AT torresbarrerag mexicanconsensusonnoncardiacchestpain AT valdovinosgarcialr mexicanconsensusonnoncardiacchestpain AT valdovinosdiazma mexicanconsensusonnoncardiacchestpain AT vazquezelizondogenaro mexicanconsensusonnoncardiacchestpain AT villarchavezas mexicanconsensusonnoncardiacchestpain AT zavalasolaresm mexicanconsensusonnoncardiacchestpain AT achemsr mexicanconsensusonnoncardiacchestpain |