Chest symptoms due to GORD/oesophaeal spasm

Non-cardiac chest pain is defined as recurring angina like substernal chest pain of non-cardiac origin. This can be a squeezing, burning substernal chest pain which can radiate to the back, neck, arms and jaws. The symptoms are intermittent and can last from minutes to days. It may also be accompanied by symptoms of GORD. Pain may be triggered by eating quickly or consuming hot, cold or carbonated drinks Whilst this needs evaluation for cardiac causes, adult patients born with OA/TOF are usually younger than typical of cardiac causes of chest pain and may lack personal and family history of cardiac disease. (123,124,125)

Diagnosis

• Normal ECG/troponin blood test/ECHO (if appropriate)
• pH monitoring/oesophageal manometry/24-hour manometry
• Gastroscopy

Treatment

1. PPIs and GORD treatment are first line treatments.
2. Smooth muscle relaxants have been used but show limited efficacy, eg diltiazem 60–90mg four times per day, nifedipine 10–30mg three times per day.
3. Nitrates have also been used, such as isosorbide mononitrate.
4. Pain modulators such as tricyclic antidepressants (eg low-dose amitryptiline) or trazadone improve symptoms due to neuromodulatory and analgesic properties. (124)

Medical interventions by gastroenterologists are sometimes used, such as botulinum toxin or balloon dilatation of the affected area. However, there is no research in the management of oesophageal spasm on the background of OA/TOF at present so it is hard to say how botulinum toxin might affect the already precarious oesophageal motility here. (125)