Systematic review: the treatment of noncardiac chest pain

Alimentary Pharmacology and Therapeutics | November 16, 2011

Hershcovici T et al. – Patients with gastro–oesophageal reflux disease(GERD)–related noncardiac chest pain should be treated with at least double dose proton pump inhibitors(PPI). The primary treatment for non–GERD–related noncardiac chest pain, regardless if oesophageal dysmotility is present, is pain modulators.


  • Systematic review of the literature that was published between January, 1980 and March, 2011 was performed.
  • 734 studies; 68 of them met entry criteria were identified.


  • Patients with GERD-related NCCP should receive proton pump inhibitors (PPI) twice daily for at least 8 weeks.
  • Smooth muscle relaxants are only recommended for temporary relief of NCCP with motility disorders.
  • Botulinum toxin injection of the distal oesophagus may be effective in the treatment of NCCP and spastic oesophageal motility disorders.
  • Studies assessing the value of tricyclic antidepressants, trazodone and selective serotonine reuptake inhibitors in NCCP are relatively small, but suggest an oesophageal analgesic effect in NCCP patients that is limited by their side effects profile.
  • Usage of theophylline to treat patients with non-GERD-related NCCP should be weighed against its potential toxicity.
  • Use of complementary medicine has been scarcely studied in NCCP.
  • Patients with coexisting psychological morbidity or those not responding to any medical therapy should be considered for psychological intervention.
  • Cognitive behavioural therapy and hypnotherapy may be useful in the treatment of NCCP.

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