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A Journal on Internal Medicine

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Panminerva Medica 2002 March;44(1):61-7

language: English

The esophageal chest pain. An update for clinicians

Durazzo M., Premoli A., Pellicano R. *, Oliaro A. **

From the Department of Internal Medicine University of Turin, Turin, Italy
*UOA­DU Gastro-Hepatology Molinette Hospital, Turin, Italy
**Department of Thoracic Surgery University of Turin, Turin, Italy


Chest ­pain is a com­mon symp­tom and ­even ­when ­there is evi­dence of ­only ­minor obstruc­tive cor­o­nary ­artery dis­ease on angio­gra­phy, it ­leads to dis­abil­ity and impos­es a sub­stan­tial eco­nom­ic bur­den on ­health ­care ­system. Gastroesophageal ­reflux dis­ease (­GERD) and esoph­a­geal dys­mo­til­ity dis­or­ders are ­thought to ­play an impor­tant ­role in the gen­e­sis of non-car­diac ­chest ­pain. Its pathog­e­net­ic mech­a­nism ­remains ­unclear.
The esoph­a­geal ori­gin of the symp­tom may be iden­ti­fied by an aggres­sive ­trial of ­high-­dose anti­se­cre­to­ry ­drugs or an abnor­mal pro­longed ambu­la­to­ry pH mon­i­tor­ing ­study. Endoscopy is ­often nor­mal and ­less use­ful in ­this pop­u­la­tion ­than in ­those ­with heart­burn as pre­sent­ing symp­tom. The use of manom­e­try, ­with pro­voc­a­tive test­ing to eval­u­ate for esoph­a­geal motil­ity abnor­mal­ities or esoph­a­geal sen­si­tiv­ity, ­allows opti­mal eval­u­a­tion of ­those who do not ­have ­GERD. Patients ­with non-car­diac ­chest ­pain of ­unknown ori­gin ­should be care­ful­ly ­screened for the occur­rence of esoph­a­geal dis­or­ders but fur­ther ­research is need­ed to clar­i­fy the ­role of the lat­ter on the path­o­gen­e­sis of ­this symp­tom.

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