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Response

Peter Unge, MD PhD
Stockholm, Swed

Lars Agréus, MD PhD
Stockholm, Swed

Björn W. Karlson, MD PhD
Mölndal, Swed

Staffan Nilsson, MD
Norrköping, Swed by e-mail

The letter from Drs Campbell and Abbass and our article¹ both serve as reminders to physicians to consider all of the important causes of chest pain, including GERD and psychiatric disease. We whole-heartedly agree with several important points in their letter. Anxiety disorders meeting DSM-IV criteria are common among patients visiting the emergency department for chest pain.² Optimal care would diagnose and manage anxiety at an early stage in order to reduce suffering and improve outcomes. We believe FPs have the expertise to provide a patient-centred approach to care that encompasses the range of physical and psychological issues involved in chest pain.

The complex interplay between the brain and the gut warrants additional emphasis. Studies show that people suffering with either chest pain or GERD will often have concomitant anxiety.^2,3 Furthermore, having an anxiety disorder does not immunize an individual against other causes of chest pain, including cardiac causes and GERD. In the same way that overemphasis on acid-related causes could distract our attention from the patients who have anxiety disorder, we must not overlook GERD or coronary artery disease in patients with panic disorder or other anxiety disorders. Comorbid conditions are common in patients with chest pain, and appropriate management is needed for both the psychological and physical components of their conditions.² The brain-to-gut and gut-to-brain connections are real and very important when assessing and managing GERD patients presenting with chest pain.^4,5

If a patient’s chest pain is caused by GERD, treatment with proton pump inhibitors can completely resolve symptoms and restore health.⁶ It is not common to have this degree of success with treatments for the other causes of chest pain and comorbid conditions. Family physicians are well positioned by virtue of their skills and ongoing care to diagnose and manage both physical and psychological diseases associated with chest pain.⁷ We are proud of the important role FPs play in the evidence-based management of chest pain, anxiety disorders, and depression.

	References

TOP References

 

1. Flook N, Unge P, Agréus L, Karlson BW, Nilsson S. Approach to managing undiagnosed chest pain. Could gastroesophageal reflux disease be the cause? Can Fam Physician 2007;53:261-6.[Abstract/Free Full Text]
2. Husser D, Bollmann A, Kuhne C, Molling J, Klein HU. Evaluation of noncardiac chest pain: diagnostic approach, coping strategies and quality of life. Eur J Pain 2006;10(1):51-5.[Medline]
3. Wiklund I. Review of the quality of life and burden of illness in gastroesophageal reflux disease. Dig Dis 2004;22(2):108-14.[Medline]
4. Kamolz T, Velanovich V. Psychological and emotional aspects of gastroesophageal reflux disease. Dis Esophagus 2002;15(3):199-203.[Medline]
5. Wiklund I, Butler-Wheelhouse P. Psychosocial factors and their role in symptomatic gastroesophageal reflux disease and functional dyspepsia. Scand J Gastroenterol Suppl 1996;220:94-100.[Medline]
6. Revicki DA, Crawley JA, Zodet MW, Levine DS, Joelsson BO. Complete resolution of heartburn symptoms and health-related quality of life in patients with gastrooesophageal reflux disease. Aliment Pharmacol Ther 1999;13(12):1621-30.[Medline]
7. Botoman VA. Noncardiac chest pain. J Clin Gastroenterol 2002;34(1):6-14.[Medline]

This Article Full Text (PDF) Rapid Responses: Submit a response Alert me when this article is cited Alert me when Rapid Responses are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Flook, N. Articles by Nilsson, S. Search for Related Content PubMed Articles by Flook, N. Articles by Nilsson, S.