Skip to main content
SpringerLink
Log in

Recent developments in chest pain of undetermined origin

  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

The syndrome of angina-like pain with normal epicardial coronary vessels is a very common and expensive clinical problem. Patients suffering from this condition frequently present a diagnostic challenge. Cardiac and musculoskeletal disorders must be excluded prior to identifying the esophagus as the source of pain. The term “chest pain of undetermined origin” (UCP) has been proposed to refer to this condition. Esophageal dysmotility was previously considered a major source for chest pain; however, recent studies indicate that esophageal reflux is the most common cause of esophageal pain. Two controlled trials of acid suppressive agents in patients with chest pain have shown that omeprazole provides effective pain relief for the majority of these individuals. Visceral hyperalgesia and psychologic disturbances are also commonly noted in patients with UCP. Much remains to be learned about the etiology of visceral hyperalgesia and the precise role of psychologic abnormalities in these patients. Until further information is available, treatment with imipramine or trazodone has been shown to offer effective relief of chest pain for subgroups of patients with UCP. Psychologic intervention is also valuable in the management of some patients. Studies of other therapeutic regimens continue to be conducted.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Graves EJ, Gillum BS: 1994 Summary: National Hospital Discharge Survey. Adv Data 1996, 1–12.

  2. White S, Morel E: 1990 National Cardiac Catheterization Laboratory Survey Findings. Billerica, MA: CR Bard; 1991.

    Google Scholar 

  3. Assey ME: The puzzle of normal coronary arteries in the patient with chest pain: what to do? Clin Cardiol 1993, 16:170–180.

    PubMed  CAS  Google Scholar 

  4. Kemp HG, Vokonas PS, Cohn PF, et al.: The anginal syndrome associated with normal coronary arteriograms: report of a six year experience. Am J Med 1973, 54:735–742.

    Article  PubMed  Google Scholar 

  5. Proudfit WL, Shirey EK, Sones FMJr: Selective cine coronary arteriography: correlation with clinical findings in 1,000 patients. Circulation 1966, 33:901–910.

    PubMed  CAS  Google Scholar 

  6. Savage DD, Devereux RB, Garrison RJ, et al.: Mitral valve prolapse in the general population. 2. Clinical features: the Framingham Study. Am Heart J 1983, 106:577–581.

    Article  PubMed  CAS  Google Scholar 

  7. Katz PO, Codario R, Castell DO: Approach to the patient with unexplained chest pain. Compr Ther 1997, 23:249–253.

    PubMed  CAS  Google Scholar 

  8. Richter JE, Dalton CB, Bradley LA, et al.: Oral nifedipine in the treatment of noncardiac chest pain in patients with the nutcracker esophagus. Gastroenterology 1987, 93:21–28.

    PubMed  CAS  Google Scholar 

  9. Richter JE, Bradley LA, Castell DO: Esophageal chest pain: current controversies in pathogenesis, diagnosis, and therapy. Ann Intern Med 1989, 110:66–78.

    PubMed  CAS  Google Scholar 

  10. Mayou R: The patient with angina: symptoms and disability. Postgrad Med J 1973, 49:250–254.

    PubMed  CAS  Google Scholar 

  11. Chambers J, Bass C: Chest pain with normal coronary anatomy: a review of natural history and possible etiologic factors. Prog Cardiovasc Dis 1990, 33:161–184.

    Article  PubMed  CAS  Google Scholar 

  12. Kemp HG, Kronmal RA, Vlietstra RE, et al.: Seven year survival of patients with normal or near normal coronary arteriograms: a CASS registry study. J Am Coll Cardiol 1986, 7:479–483.

    Article  PubMed  CAS  Google Scholar 

  13. Katz PO, Dalton CB, Richter JE, et al.: Esophageal testing of patients with noncardiac chest pain or dysphagia: results of three years' experience with 1161 patients. Ann Intern Med 1987, 106:593–597.

    PubMed  CAS  Google Scholar 

  14. Herrington JP, Burns TW, Balart LA: Chest pain and dysphagia in patients with prolonged peristaltic contractile duration of the esophagus. Dig Dis Sci 1984, 29:134–140.

    Article  PubMed  CAS  Google Scholar 

  15. Spencer J: Prolonged pH recording in the study of gastrooesophageal reflux. Br J Surg 1969, 56:912–914.

    Article  PubMed  CAS  Google Scholar 

  16. Chambers J, Bass C: Atypical chest pain: looking beyond the heart. QJM 1998, 91:239–244.

    Article  PubMed  CAS  Google Scholar 

  17. Pyorala K, De Backer G, Graham I, et al.: Prevention of coronary heart disease in clinical practice: recommendations of the Task Force of the European Society of Cardiology, European Atherosclerosis Society and European Society of Hypertension. Eur Heart J 1994, 15:1300–1331.

    PubMed  CAS  Google Scholar 

  18. Cooke RA, Smeeton N, Chambers JB: Comparative study of chest pain characteristics in patients with normal and abnormal coronary angiograms. Heart 1997, 78:142–146.

    PubMed  CAS  Google Scholar 

  19. Wise CM: Chest wall syndromes [editorial]. Curr Opin Rheumatol 1994, 6:197–202.

    Article  PubMed  CAS  Google Scholar 

  20. Wolf E, Stern S: Costosternal syndrome: its frequency and importance in differential diagnosis of coronary heart disease. Arch Intern Med 1976, 136:189–191.

    Article  PubMed  CAS  Google Scholar 

  21. BechgaardP: Segmental thoracic pain in patients admitted to a medical department and a coronary unit. Acta Med Scand Suppl 1981, 644:87–89.

    PubMed  CAS  Google Scholar 

  22. Wise CM, Semble EL, Dalton CB: Musculoskeletal chest wall syndromes in patients with noncardiac chest pain: a study of 100 patients. Arch Phys Med Rehabil 1992, 73:147–149.

    PubMed  CAS  Google Scholar 

  23. Leite LP, Johnston BT, Barrett J, et al.: Ineffective esophageal motility (IEM): the primary finding in patients with nonspecific esophageal motility disorder. Dig Dis Sci 1997, 42:1859–1865.

    Article  PubMed  CAS  Google Scholar 

  24. Achem SR, Benjamin S: Esophageal dysmotility (spastic dysmotility). In The Esophagus, edn 2. Edited by Castell DO. Boston: Little, Brown; 1995:247–268.

    Google Scholar 

  25. Achem SR, Kolts BE: Current medical therapy for esophageal motility disorders. Am J Med 1992, 92:98S-105S.

    Article  PubMed  CAS  Google Scholar 

  26. Balaban DH, Yamamoto Y, Liu J, et al.: Sustained esophageal contraction: a marker of esophageal chest pain identified by intraluminal ultrasonography. Gastroenterology 1999, 116:29–37. Recent study implicating that chest pain is due to a “sustained esophageal contraction” detected by high frequency ultrasonography.

    Article  PubMed  CAS  Google Scholar 

  27. Rao SS, Gregersen H, Hayek B, et al.: Unexplained chest pain: the hypersensitive, hyperreactive, and poorly compliant esophagus. Ann Intern Med 1996, 124:950–958.

    PubMed  CAS  Google Scholar 

  28. Janssens J, Vantrappen G, Ghillebert G: Twenty-four-hour recording of esophageal pressure and pH in patients with noncardiac chest pain. Gastroenterology 1986, 90:1978–1984.

    PubMed  CAS  Google Scholar 

  29. Peters L, Maas L, Petty D, et al.: Spontaneous noncardiac chest pain: evaluation by 24-hour ambulatory esophageal motility and pH monitoring. Gastroenterology 1988, 94:878–886.

    PubMed  CAS  Google Scholar 

  30. Soffer EE, Scalabrini P, Wingate DL: Spontaneous noncardiac chest pain: value of ambulatory esophageal pH and motility monitoring. Dig Dis Sci 1989, 34:1651–1655.

    Article  PubMed  CAS  Google Scholar 

  31. Hewson EG, Dalton CB, Richter JE: Comparison of esophageal manometry, provocative testing, and ambulatory monitoring in patients with unexplained chest pain. Dig Dis Sci 1990, 35:302–309.

    Article  PubMed  CAS  Google Scholar 

  32. Ghillebert G, Janssens J, Vantrappen G, et al.: Ambulatory 24 hour intraoesophageal pH and pressure recordings versus provocation tests in the diagnosis of chest pain of oesophageal origin. Gut 1990, 31:738–744.

    PubMed  CAS  Google Scholar 

  33. Paterson WG, Abdollah H, Beck IT, et al.: Ambulatory esophageal manometry, pH-metry, and Holter ECG monitoring in patients with atypical chest pain. Dig Dis Sci 1993, 38:795–802.

    Article  PubMed  CAS  Google Scholar 

  34. DeMeester TR, O'Sullivan GC, Bermudez G, et al.: Esophageal function in patients with angina-type chest pain and normal coronary angiograms. Ann Surg 1982, 196:488–498.

    Article  PubMed  CAS  Google Scholar 

  35. Hewson EG, Sinclair JW, Dalton CB, et al.: Twenty-four-hour esophageal pH monitoring: the most useful test for evaluating noncardiac chest pain. Am J Med 1991, 90:576–583.

    PubMed  CAS  Google Scholar 

  36. Achem SR, Lyles WE, Kolts BE: Coexistence of reflux in patients with abnormal esophageal motility. Gastroenterology 1992, 102:31.

    Google Scholar 

  37. Ho KY, Ng WL, Kang JY, et al.: Gastroesophageal reflux disease is a common cause of noncardiac chest pain in a country with a low prevalence of reflux esophagitis. Dig Dis Sci 1998, 43:1991–1997.

    Article  PubMed  CAS  Google Scholar 

  38. Achem SR, Kolts BE, Wears R, et al.: Chest pain associated with nutcracker esophagus: a preliminary study of the role of gastroesophageal reflux. Am J Gastroenterol 1993, 88:187–192.

    PubMed  CAS  Google Scholar 

  39. Stahl WG, Beton RR, Johnson CS, et al.: Diagnosis and treatment of patients with gastroesophageal reflux and noncardiac chest pain. South Med J 1994, 87:739–742.

    Article  PubMed  CAS  Google Scholar 

  40. Achem SR, DeVault KR: Unexplained chest pain at the turn of the century. Am J Gastroenterology 1999, 94:5–8.

    Article  CAS  Google Scholar 

  41. Achem SR, Kolts BE, MacMath T, et al.: Effects of omeprazole versus placebo in treatment of noncardiac chest pain and gastroesophageal reflux. Dig Dis Sci 1997, 42:2138–2145. First published double-blind, placebo-controlled trial of omeprazole in patients with chest pain and coexisting reflux.

    Article  PubMed  CAS  Google Scholar 

  42. Fass R, Fennerty MB, Ofman JJ, et al.: The clinical and economic value of a short course of omeprazole in patients with noncardiac chest pain. Gastroenterology 1998, 115:42–49.

    Article  PubMed  CAS  Google Scholar 

  43. Castell DO, Katz PO: The acid suppression test for unexplained chest pain [editorial]. Gastroenterology 1998, 115:222–224.

    Article  PubMed  CAS  Google Scholar 

  44. Cherian P, Smith LF, Bardham KD, et al.: Esophageal tests in the evaluation of noncardiac chest pain. Dis Esophagus 1995, 8:129–133.

    Google Scholar 

  45. Ofman JJ, Gralnek IM, Udani J, et al.: The cost-effectiveness of the omeprazole test in patients with noncardiac chest pain. Am J Med 1999, 107:219–227. Analytic model recommending empiric therapeutic trial as opposed to diagnostic investigations in patients with unexplained chest pain or gastroesophageal reflux.

    Article  PubMed  CAS  Google Scholar 

  46. Peghini PL, Katz PO, Bracy NA, Castell DO: Nocturnal recovery of gastric acid secretion with twice-daily dosing of proton pump inhibitors. Am J Gastroenterol 1998, 93:763–767.

    Article  PubMed  CAS  Google Scholar 

  47. Dwyer EMJr, Wiener L, Cox JW: Angina pectoris in patients with normal and abnormal coronary arteriograms. Am J Cardiol 1969, 23:639–646.

    Article  PubMed  Google Scholar 

  48. Neill WA, Judkins MP, Dhindsa DS, et al.: Clinically suspect ischemic heart disease not corroborated by demonstrable coronary artery disease: physiologic investigations and clinical course. Am J Cardiol 1972, 29:171–179.

    Article  PubMed  CAS  Google Scholar 

  49. Bemiller CR, Pepine CJ, Rogers AK: Long-term observations in patients with angina and normal coronary arteriograms. Circulation 1973, 47:36–43.

    PubMed  CAS  Google Scholar 

  50. Arbogast R, Bourassa MG: Myocardial function during atrial pacing in patients with angina pectoris and normal coronary arteriograms: comparison with patients having significant coronary artery disease. Am J Cardiol 1973, 32:257–263.

    Article  PubMed  CAS  Google Scholar 

  51. Cannon RO III, Watson RM, Rosing DR, et al.: Angina caused by reduced vasodilator reserve of the small coronary arteries. J Am Coll Cardiol 1983, 1:1359–1373.

    Article  PubMed  Google Scholar 

  52. CannonRO III: Microvascular angina: cardiovascular investigations regarding pathophysiology and management. Med Clin North Am 1991, 75:1097–1118.

    PubMed  Google Scholar 

  53. CannonRO III, Cattau ELJr, Yakshe PN, et al.: Coronary flow reserve, esophageal motility, and chest pain in patients with angiographically normal coronary arteries. Am J Med 1990, 88:217–222.

    Article  PubMed  Google Scholar 

  54. Castell DO: Chest pain of undetermined origin: overview of pathophysiology. Am J Med 1992, 92:2S-4S.

    Article  PubMed  CAS  Google Scholar 

  55. Borjesson M, Albertsson P, Dellborg M, et al.: Esophageal dysfunction in syndrome X. Am J Cardiol 1998, 82:1187–1191.

    Article  PubMed  CAS  Google Scholar 

  56. Clouse RE, Lustman PJ: Psychiatric illness and contraction abnormalities of the esophagus. N Engl J Med 1983, 309:1337–1342.

    Article  PubMed  CAS  Google Scholar 

  57. Richter JE, Barish CF, Castell DO: Abnormal sensory perception in patients with esophageal chest pain. Gastroenterology 1986, 91:845–852.

    PubMed  CAS  Google Scholar 

  58. Richter JE, Obrecht WF, Bradley LA, et al.: Psychological comparison of patients with nutcracker esophagus and irritable bowel syndrome. Dig Dis Sci 1986, 31:131–138.

    Article  PubMed  CAS  Google Scholar 

  59. Bass C, Wade C: Chest pain with normal coronary arteries: a comparative study of psychiatric and social morbidity. Psychol Med 1984, 14:51–61.

    Article  PubMed  CAS  Google Scholar 

  60. Beitman BD, Basha I, Flaker G, et al.: Atypical or nonanginal chest pain: panic disorder or coronary artery disease? Arch Intern Med 1987, 147:1548–1552.

    Article  PubMed  CAS  Google Scholar 

  61. Ho KY, Kang JY, Yeo B, et al.: Non-cardiac, non-oesophageal chest pain: the relevance of psychological factors. Gut 1998, 43:105–110.

    Article  PubMed  CAS  Google Scholar 

  62. Mayou RA, Bryant BM, Sanders D, et al.: A controlled trial of cognitive behavioural therapy for non-cardiac chest pain. Psychol Med 1997, 27:1021–1031.

    Article  PubMed  CAS  Google Scholar 

  63. Klimes I, Mayou RA, Pearce MJ, et al.: Psychological treatment for atypical non-cardiac chest pain: a controlled evaluation. Psychol Med 1990, 20:605–611.

    Article  PubMed  CAS  Google Scholar 

  64. Shapiro LM, Crake T, Poole-Wilson PA: Is altered cardiac sensation responsible for chest pain in patients with normal coronary arteries? Clinical observation during cardiac catheterisation. Br Med J (Clin Res Ed) 1988, 296:170–171.

    CAS  Google Scholar 

  65. Cannon ROIII, Quyyumi AA, Schenke WH, et al.: Abnormal cardiac sensitivity in patients with chest pain and normal coronary arteries. J Am Coll Cardiol 1990, 16:1359–1366.

    Article  PubMed  Google Scholar 

  66. Chauhan A, Mullins PA, Thuraisingham SI, et al.: Abnormal cardiac pain perception in syndrome X. J Am Coll Cardiol 1994, 24:329–335.

    Article  PubMed  CAS  Google Scholar 

  67. Lagerqvist B, Sylven C, Waldenstrom A: Lower threshold for adenosine-induced chest pain in patients with angina and normal coronary angiograms. Br Heart J 1992, 68:282–285.

    PubMed  CAS  Google Scholar 

  68. Rosen SD, Uren NG, Kaski JC, et al.: Coronary vasodilator reserve, pain perception, and sex in patients with syndrome X. Circulation 1994, 90:50–60.

    PubMed  CAS  Google Scholar 

  69. Lasch H, DeVault KR, Castell DO: Intraesophageal balloon distention in the evaluation of sensory thresholds: studies on reproducibility and comparison of balloon composition. Am J Gastroenterol 1994, 89:1185–1190.

    PubMed  CAS  Google Scholar 

  70. Nguyen P, Castell DO: Evidence for sex differences in esophageal pain threshold [abstract]. Gastroenterology 1993, 104:158A.

    Google Scholar 

  71. Hazan S, Steinberg A, Morris N, et al.:Long-term reproducibility of intraesophageal balloon distension studies in patients with unexplained chest pain [abstract]. Gastroenterology 1997, 112(suppl):A145.

    Google Scholar 

  72. Hu WH, Talley NJ: Visceral perception in functional gastro-intestinal disorders: disease marker or epiphenomenon? Dig Dis Sci 1996, 14:276–288.

    Article  CAS  Google Scholar 

  73. Mertz H, Naliboff B, Munakata J, et al.: Altered rectal perception is a biological marker of patients with irritable bowel syndrome. Gastroenterology 1995, 109:40–52.

    Article  PubMed  CAS  Google Scholar 

  74. Kellow JE: Sphincter of Oddi dysfunction type III: another manifestation of visceral hyperalgesia? [editorial]. Gastroenterology 1999, 116:996–1000.

    Article  PubMed  CAS  Google Scholar 

  75. Sengupta JN, Kauvar D, Goyal RK: Characteristics of vagal esophageal tension-sensitive afferent fibers in the opossum. J Neurophysiol 1989, 61:1001–1010.

    PubMed  CAS  Google Scholar 

  76. Sengupta JN, Saha JK, Goyal RK: Stimulus-response function studies of esophageal mechanosensitive nociceptors in sympathetic afferents of opossum. J Neurophysiol 1990, 64:796–812.

    PubMed  CAS  Google Scholar 

  77. de Caestecker JS, Pryde A, Heading RC: Site and mechanism of pain perception with oesophageal balloon distension and intravenous edrophonium in patients with oesophageal chest pain. Gut 1992, 33:580–586.

    PubMed  Google Scholar 

  78. Hollerbach S, Hudoba P, Fitzpatrick D, et al.: Cortical evoked responses following esophageal balloon distension and electrical stimulation in healthy volunteers. Dig Dis Sci 1998, 43:2558–2566.

    Article  PubMed  CAS  Google Scholar 

  79. Ejima FH, Dantas RO, Simoes MV, et al.: Intraesophageal balloon distension test in Chagas' disease patients with noncardiac chest pain. Dig Dis Sci 1998, 43:2567–2571.

    Article  PubMed  CAS  Google Scholar 

  80. DeVault KR, Beacham S, Castell DO, et al.: Esophageal sensation in spinal cord-injured patients: balloon distension and cerebral evoked potential recording. Am J Physiol 1996, 271:G937-G941.

    PubMed  CAS  Google Scholar 

  81. Smout AJ, DeVore MS, Dalton CB, et al.: Cerebral potentials evoked by oesophageal distension in patients with noncardiac chest pain. Gut 1992, 33:298–302.

    PubMed  CAS  Google Scholar 

  82. Aziz Q, Andersson JL, Valind S, et al.: Identification of human brain loci processing esophageal sensation using positron emission tomography. Gastroenterology 1997, 113:50–59.

    Article  PubMed  CAS  Google Scholar 

  83. Lenz FA, Dougherty PM, Traill TA: Thalamic mechanisms of chest pain in the absence of cardiac pathology [editorial]. Heart 1996, 75:429–430.

    PubMed  CAS  Google Scholar 

  84. Lenz FA, Gracely RH, Hope EJ, et al.: The sensation of angina can be evoked by stimulation of the human thalamus. Pain 1994, 59:119–125.

    Article  PubMed  CAS  Google Scholar 

  85. Lenz FA, Gracely RH, Romanoski AJ, et al.: Stimulation in the human somatosensory thalamus can reproduce both the affective and sensory dimensions of previously experienced pain. Nat Med 1995, 1:910–913.

    Article  PubMed  CAS  Google Scholar 

  86. McDonald-Haile J, Bradley LA, Bailey MA: Lower regional cerebral blood flow to caudate nuclei is associated with chest pain of undetermined etiology [abstract]. Gastroenterology 1994, 106:1038A.

    Google Scholar 

  87. Bradley LA, Richter JE, Scarinci IC, et al.: Psychosocial and psychophysical assessments of patients with unexplained chest pain. Am J Med 1992, 92:65S-73S.

    Article  PubMed  CAS  Google Scholar 

  88. Bradley LA, Scarinci IC, Richter JE: Pain threshold levels and coping strategies among patients who have chest pain and normal coronary arteries. Med Clin North Am 1991, 75:1189–1202.

    PubMed  CAS  Google Scholar 

  89. Mayer EA, Gebhart GF: Basic and clinical aspects of visceral hyperalgesia. Gastroenterology 1994, 107:271–293.

    PubMed  CAS  Google Scholar 

  90. Bromm B, Meier W, Scharein E: Imipramine reduces experimental pain. Pain 1986, 25:245–257.

    Article  PubMed  CAS  Google Scholar 

  91. Myren J, Lovland B, Larssen SE, et al.: A double-blind study of the effect of trimipramine in patients with the irritable bowel syndrome. Scand J Gastroenterol 1984, 19:835–843.

    PubMed  CAS  Google Scholar 

  92. Cannon RO III, Quyyumi AA, Mincemoyer R, et al.: Imipramine in patients with chest pain despite normal coronary angiograms. N Engl J Med 1994, 330:1411–1417.

    Article  PubMed  Google Scholar 

  93. Peghini PL, Katz PO, Castell DO: Imipramine decreases oesophageal pain perception in human male volunteers. Gut 1998, 42:807–813.

    Article  PubMed  CAS  Google Scholar 

  94. Clouse RE, Lustman PJ, Eckert TC, et al.: Low-dose trazodone for symptomatic patients with esophageal contraction abnormalities: a double-blind, placebo-controlled trial. Gastroenterology 1987, 92:1027–1036.

    PubMed  CAS  Google Scholar 

  95. Prakash C, Clouse RE: Long-term outcome from tricyclic antidepressant treatment of functional chest pain. Dig Dis Sci 1999, 44:2373–2379.

    Article  PubMed  CAS  Google Scholar 

  96. Brown SR, Schwartz JM, Summergrad P, et al.: Globus hystericus syndrome responsive to antidepressants. Am J Psychiatry 1986, 143:917–918.

    PubMed  CAS  Google Scholar 

  97. Plourde V, Lembo T, Shui Z, et al.: Effects of the somatostatin analogue octreotide on rectal afferent nerves in humans. Am J Physiol 1993, 265:G742-G751.

    PubMed  CAS  Google Scholar 

  98. Bradette M, Delvaux M, Staumont G, et al.: Octreotide increases thresholds of colonic visceral perception in IBS patients without modifying muscle tone. Dig Dis Sci 1994, 39:1171–1178.

    Article  PubMed  CAS  Google Scholar 

  99. Hasler WL, Soudah HC, Owyang C: Somatostatin analog inhibits afferent response to rectal distention in diarrhea-predominant irritable bowel patients. J Pharmacol Exp Ther 1994, 268:1206–1211.

    PubMed  CAS  Google Scholar 

  100. Johnston BT, Shils J, Leite LP, et al.: Effects of octreotide on esophageal visceral perception and cerebral evoked potentials induced by balloon distention. Am J Gastroenterol 1999, 94:65–70.

    Article  PubMed  CAS  Google Scholar 

  101. Hazan S, Buckley E, Castell DO, et al.: Octreotide improves sensory and pain thresholds in patients with noncardiac chest pain [abstract]. Gastroenterology 1996, 110:A132.

    Google Scholar 

  102. Delvaux M, Louvel D, Mamet JP, et al.: Effect of alosetron on responses to colonic distension in patients with irritable bowel syndrome. Aliment Pharmacol Ther 1998, 12:849–855.

    Article  PubMed  CAS  Google Scholar 

  103. Riviere PJ, Pascaud X, Chevalier E, et al.: Fedotozine reversal of peritoneal-irritation-induced ileus in rats: possible peripheral action on sensory afferents. J Pharmacol Exp Ther 1994, 270:846–850.

    PubMed  CAS  Google Scholar 

  104. Delvaux M, Louvel D, Lagier E, et al.: The kappa agonist fedotozine relieves hypersensitivity to colonic distention in patients with irritable bowel syndrome. Gastroenterology 1999, 116:38–45

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Mayo School of Medicine, Mayo Clinic Jacksonville, 4500 San Pablo Road, 32224, Jacksonville, FL, USA

    Sami R. Achem MD & Kenneth R. De Vault MD

Authors
  1. Sami R. Achem MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kenneth R. De Vault MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Achem, S.R., De Vault, K.R. Recent developments in chest pain of undetermined origin. Curr Gastroenterol Rep 2, 201–209 (2000). https://doi.org/10.1007/s11894-000-0062-4

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11894-000-0062-4

Keywords

Search

Navigation