22. Functional chest pain: nociception and visceral hyperalgesia. 8. 62. Esophageal hypersensitivity is defined as the perception of non-painful esophageal stimuli as being painful and the perception of painful esophageal stimuli as being more painful. Rome III criteria define this condition as episodes of unexplained chest pain that are usually midline in location and of visceral quality; therefore, these episodes are potentially of esophageal origin.The exact prevalence of ECP is difficult to estimate because its diagnosis requires the use of multiple diagnostic tests to exclude other conditions. The color depicts pressure from low (blue) to high (red); note how the waves of contraction (high pressure) proceed from proximal (top) to distal (bottom).In our patient with functional heartburn, 24-hour wireless esophageal pH testing showed a pH greater than 4 (the conventional cutoff in esophageal pH testing) for most of the test. 27. But even if the esophageal mucosa appears normal, the proximal and distal esophagus should be biopsied to rule out an inflammatory disorder such as eosinophilic or lymphocytic esophagitis.If endoscopic and esophageal biopsy results are inconclusive, a workup for an esophageal motility disorder is the next step. Henderson RD, Ryder D, Marryatt G. Extended esophageal myotomy and short total fundoplication hernia repair in diffuse esophageal spasm: five-year review in 34 patients. 34. These tests should facilitate an accurate diagnosis of ECP. Balaban DH, Yamamoto Y, Liu J, et al. Hobson AR, Furlong PL, Sarkar S, et al. This pH test is consistent with a diagnosis of functional heartburn. Lee H, Kim JH, Min BH, et al. 18. Eslick GD, Coulshed DS, Talley NJ. Fass R, Fennerty MB, Ofman JJ, et al. The Table shows common etiologies, pathophysiologies, and treatments of esophageal chest pain.Acid reflux causes ECP, but it is only one of many components of a complex, multifactorial disorder.Several PPIs, including omeprazole, lansoprazole, and rabeprazole, have been examined. Consequently, these patients report a diminished quality of life. Finally Broekaert and colleagues evaluated the acute effect of citalopram on esophageal hypersensitivity, stating that administration of the drug lowered chemical and mechanical esophageal sensitivity, without altering the motility [Broekaert et al. Functional heartburn—persistent symptoms of esophageal reflux with no objective evidence of gastroesophageal reflux disease (GERD)—is the most common cause of failure of proton pump inhibitor (PPI) therapy, but it is often overlooked by internists and gastroenterologists.Functional heartburn accounts for more than half of all referrals for PPI-refractory GERD.Diagnostic criteria require at least 3 months of symptoms in the 6 months before presentation.Results of upper endoscopy with biopsy, esophageal manometry, and esophageal pH monitoring must be normal.Patient education is key, with reassurance that the risk of progression to malignancy is low in the absence of Bar-rett esophagus, and that the condition remits spontaneously in up to 40% of cases.Neuromodulators to reduce pain perception are the mainstay of treatment for functional gastrointestinal disorders such as functional heartburn. 25,26 In one study, 83% of ECP patients reported … Non-cardiac chest pain: predictors of health care seeking, the types of health care professional consulted, work absenteeism and interruption of daily activities. Sarkar S, Aziz Q, Woolf CJ, Hobson AR, Thompson DG. Storr M, Allescher HD, Rösch T, Born P, Weigert N, Classen M. Treatment of symptomatic diffuse esophageal spasm by endoscopic injections of botulinum toxin: a prospective study with long-term follow-up. Results of three years’ experience with 1161 patients. © 2020 - Millennium Medical Publishing - All Rights Reserved Esophageal hypersensitivity is believed to be a key mechanism for ECP and considered a hallmark of this condition. 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