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How to Diagnose and Treat Functional Chest Pain

Opinion statement

Chest pain that is not explained by reflux disease or cardiac, musculoskeletal, mucosal, or motor esophageal abnormalities is classified as functional chest pain (FCP). Although several mechanisms are involved, esophageal hypersensitivity plays a major role and it could be considered a biomarker for FCP. Psychologic comorbidity such as anxiety, neuroticism, depression, and somatization is common. When the diagnosis of FCP is suspected, patients should undergo evaluation with esophageal motility testing, endoscopy, 24-h esophageal pH monitoring, and in some cases, sensory tests. Once the diagnosis of FCP has been established, treatment options rely on controlling patients’ symptoms. Medical treatment has focused predominantly on medications that target pain, such as antidepressants and other pain neuromodulators. Non-pharmacologic interventions with complementary behavioral treatments, such as cognitive behavioral therapy, biofeedback, and hypnosis, have recently been recognized as useful in FCP patients. The latest findings on the evaluation and treatment of FCP are outlined herein.

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Correspondence to Jose M. Remes-Troche M.D..

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José Maria Remes-Troche has served as a member of the advisory board for Commonwealth, Allergan and Carnot; has received grant support for research from Sanfer and Asofarma; and also has served as speaker for Takeda, Allergan, Carnot, Menarini and Sanfer.

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This article is part of the Topical Collection on Motility

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Remes-Troche, J.M. How to Diagnose and Treat Functional Chest Pain. Curr Treat Options Gastro 14, 429–443 (2016). https://doi.org/10.1007/s11938-016-0106-y

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Keywords

  • Functional chest pain
  • Antidepressants
  • Pain modulators
  • Esophagus
  • Hypersensitivity