Noncardiac XXXX : evaluation and treatment.

@entity662 @entity1 @entity1318 @entity146 @entity5837 @entity354 @entity158 @entity4423
Noncardiac @entity662 is a heterogeneous condition for which diagnosis and treatment are challenging. Research is needed to streamline evaluation to minimize unnecessary invasive testing and costs. @entity662 clinics to assess @entity662 @entity1 are popular in the United States and may be of value in reassuring @entity1 and reducing presentation to hospital; however, recently this has been contended [111]. Options for the effective treatment of NCCP are dependent on the risk of an adverse outcome and the cost-effectiveness of the management algorithm that is followed. Most (64%) of those presenting to the emergency department with @entity662 are classified as having NCCP [112,113]. @entity354 is probably the most important cause and application of a test of acid suppression with a high-dose PPI for 1 to 2 weeks seems to be a useful diagnostic tool. In those @entity1 with @entity354 -related NCCP, short-term and potentially long-term therapy with a PPI (commonly higher than standard dose) is required to alleviate symptoms. @entity4423 is relatively uncommon in @entity1 with NCCP and evaluation by esophageal manometry might be limited to rule out @entity1318 . @entity5837 are common but probably often missed. Many @entity1 with NCCP have psychologic or @entity146 , as either the cause or an effect of the @entity662 , but diagnosis here depends on techniques not applied easily in the acute situation. @entity158 modulators seem to offer significant improvement in @entity662 for non- @entity354 -related NCCP. Finally, trials of management strategies to deal with this problem are required urgently, because the earlier discharge of @entity1 with NCCP may exacerbate the problem. Fig. 2 provides a flow chart for diagnosis and treatment of NCCP.
