Noncardiac XXXX : update on the diagnosis and management.

@entity662 @entity1 @entity458 @entity951 @entity56 @entity354 @entity4423
Noncardiac @entity662 (NCCP) is defined as recurring, @entity951 -like, @entity662 of noncardiac origin. Although @entity1 with NCCP have excellent long-term prognosis, most suffer persistently from their symptoms. Several pathophysiological mechanisms have been suggested, including @entity354 ( @entity354 ), @entity4423 , @entity56 , and @entity458 . Among them, @entity354 is the most common cause of NCCP. Therefore, @entity354 should first be considered as the underlying cause of symptoms in @entity1 with NCCP. Empirical proton pump inhibitor (PPI) treatment with a preferably double dose for more than 2 months could be cost-effective. PPI test can also be used for diagnosis of @entity354 -related NCCP, but it should be considered for @entity1 with NCCP occurring at least weekly and its duration should be at least 2 weeks. However, upper endoscopy and esophageal pH monitoring are necessary when the diagnosis of @entity354 is uncertain. Esophageal impedance-pH monitoring could further improve the diagnostic yield. @entity1 with @entity354 -related NCCP should preferably be treated with a double dose PPI until symptoms remit (may require more than 2 months of therapy for optimal symptom control), followed by dose tapering to determine the lowest PPI dose that can control symptoms. However, treatment of @entity1 with non- @entity354 -related NCCP is challenging. An empirical treatment of antidepressants could be considered. If there are specific @entity4423 , smooth muscle relaxants or endoscopic treatment may be considered in selected cases. If none of these traditional treatments is effective, a psychology consultation for cognitive behavioral therapy should be considered.
