The Mexican consensus on non-cardiac chest pain

Gómez Escudero, O. y Coss Adame, E. y Amieva Balmori, M. y Carmona Sánchez, R.I. y Remes Troche, José M. y Abreu y 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

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Resumen

Introduction: Non-cardiac chest pain is defined as a clinical syndrome characterized by ret-rosternal pain similar to that of angina pectoris, but of non-cardiac origin and produced byesophageal, 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 forthose patients. Methods Three general coordinators carried out a literature review of all articles published inEnglish and Spanish on the theme and formulated 38 initial statements, dividing them into 3 maincategories: 1) definitions, epidemiology, and pathophysiology, 2) diagnosis, and 3) treatment.The statements underwent 3 rounds of voting, utilizing the Delphi system. The final statementswere those that reached > 75% agreement, and they were rated utilizing the GRADE system. Results and conclusions The final consensus included 29 statements. All patients presentingwith 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 initialapproach should be a therapeutic trial with a proton pump inhibitor for 2-4 weeks. If dysphagiaor alarm symptoms are present, endoscopy is recommended. High-resolution manometry isthe best method for ruling out spastic motor disorders and achalasia and pH monitoring aidsin demonstrating abnormal esophageal acid exposure. Treatment should be directed at thepathophysiologic mechanism. It can include proton pump inhibitors, neuromodulators and/orsmooth muscle relaxants, psychologic intervention and/or cognitive therapy, and occasionallysurgery or endoscopic therapy.

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