Novel way for treating non-cardiac chest pain due to esophageal hypersensitivity

Temple University Health SystemOct 22 2014

Chest pain doesn't necessarily come from the heart. An estimated 200,000 Americans each year experience non-cardiac chest pain, which in addition to pain can involve painful swallowing, discomfort and anxiety. Non-cardiac chest pain can be frightening for patients and result in visits to the emergency room because the painful symptoms, while often originating in the esophagus, can mimic a heart attack. Current treatment — which includes pain modulators such as selective serotonin reuptake inhibitors (SSRI) — has a partial 40 to 50 percent response rate in alleviating symptoms.

New research authored by Temple University Hospital gastroenterologist Ron Schey, MD, FACG, suggests a novel approach to treating non-cardiac chest pain due to esophageal hypersensitivity. The treatment involves a drug called dronabinol, a cannabinoid receptor activator that has traditionally been used to treat nausea and vomiting in HIV patients and for cancer patients undergoing chemotherapy,

In a pilot study involving 13 patients with non-cardiac chest pain, Dr. Schey and his research team found that patients who were given 5 mg of dronabinol twice daily for four weeks fared better than patients who took a placebo, or dummy pill. Those getting dronabinol experienced improved pain tolerance and decreased frequency and intensity of chest pain. In addition, no significant adverse effects were reported.

"This novel study has promising findings in future treatment for these patients," said Dr. Schey, Associate Professor of Medicine at Temple University School of Medicine, who conducted the research while on staff at the University of Iowa Hospitals and Clinic, and analyzed the data at Temple along with Zubair Malik, MD, a first-year fellow in Temple's Division of Gastroenterology.

The pilot study, while encouraging, was very small and not designed to test dronabinol against current therapies for non-cardiac chest pain, so it is difficult to calculate how the drug performs in comparison to existing treatments, Dr. Schey said. He said dronabinol likely helps to diminish pain by activating cannabinoid receptors in the esophagus that decrease sensitivity.

The abstract was presented October 20 in Philadelphia at the Annual Scientific Meeting of the American College of Gastroenterology. The professional organization said it picked the Temple research to be among the "most newsworthy" studies presented at the conference because the findings have an impact on GI patient care.

Dr. Schey joined Temple in 2014; and his research interests include non-cardiac chest pain, GI motility disorders and esophageal disorders.

Dr. Schey said a larger scale study on the effects of dronabinol on non-cardiac chest pain will be initiated in the near future at Temple.