Management of Non-Cardiac Chest Pain (NCCP) With Esophageal Motility Disorders

20 Jan 2022 04:00 06:00
Kuala-Lumpur
Justin Yeong Yeh Lee  Host

Patient Profile & Clinical History

  • Patient: 62-year-old Iraqi male

  • Initial Presentation: First seen in 2016 with no significant past medical history, presented with chest pain.

  • Cardiac Workup: Cardiac workup was normal.

Initial Diagnostic Evaluation

  • Upper Endoscopy: Initially normal.

  • High-Resolution Manometry: Showed EGJ outflow obstruction.

  • Treatment: Following balloon dilation, chest pain resolved.

Recurrence of Symptoms

2019

  • Clinical Presentation: Recurrence of chest pain.

  • Upper Endoscopy: Mild erosive esophagitis.

  • Manometry: Normal.

  • pH-Impedance: Indicated reflux hypersensitivity.

  • Medical Treatment: Dexlansoprazole, escitalopram and alginate.

  • Response: Initial therapeutic response, but chest pain somewhat persisted.

Further Physiological Evaluation

  • High-Resolution Manometry: Repeated with provocative tests and showed a hypercontractile esophagus.

  • Treatment: Botox injection was performed.

Additional Medical History

  • Breast Cancer: Intraductal papillary carcinoma was diagnosed in this patient.

  • Management: Managed conservatively with tamoxifen.

Last Clinical Follow-up

At the time of the last clinic visit in September 2021, the patient was doing well, with only very occasional chest pain.

Discussion

Management of NCCP.

Panel for Discussion

Local: Justin Yeong Yeh Lee, GI motility | Tai Pei Oon, GI motility | Seoparjoo Azmel, Pathology | Kelvin Voon, Surgery

International: George Triadafilopoulos, Gastroenterology-Endoscopy (Stanford, USA) | John Clarke, Gastroenterology (Stanford, USA) | Udai Chand Ghoshal, Gastroenterology (Lucknow, India) | Radu Tutuian, Gastroenterology (Bern, Switzerland)