PPI's and SSRI's Therapy for the Management of NCCP
Status:
Terminated
Trial end date:
2017-12-01
Target enrollment:
Participant gender:
Summary
Non cardiac chest pain (NCCP) is defined as recurring, angina-like, retrosternal chest pain
of non cardiac origin. Annual prevalence of NCCP in the general population of the western
world ranges from 25-35%. Of those patients presenting to an emergency room with chest pain,
a cardiac etiology is ultimately found in only 11-39%. Several conditions are associated with
NCCP, with gastroesophageal reflux disease (GERD) being the most prevalent, constituting up
to 60% of cases. However, NCCP is considered a disorder of heterogenous nature and several
other conditions, apart of GERD, such as esophageal dysmotility and esophageal
hypersensitivity have been implicated.
Treatment of NCCP remains a real challenge due to the diverse underlying mechanisms
responsible for patients' symptoms. Given the fact that GERD is by far the most common
etiology, proton pump inhibitor (PPI) therapy has been tried extensively; however, after 6
weeks of treatment complete resolution of symptoms occurs in only 30% of patients, the
optimal duration of PPI administration is not known, while the best maintenance dose has
never been determined. Although the administration of selective serotonin reuptake inhibitors
(SSRIs) could theoretically benefit those patients with esophageal hypersensitivity, the
trials that have been published so far have included small number of patients and reported
conflicting results, while the co-administration of PPIs with SSRIs has not been evaluated so
far. Furthermore, data on treatment of patients with functional chest pain are lacking.