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A critical approach to noncardiac chest pain: pathophysiology, diagnosis, and treatment

J Fang1, D Bjorkman

  • 1Department of Gastroenterology and Hepatology, University of Utah Health Sciences Center, Salt Lake City 84105, USA.

The American Journal of Gastroenterology
|April 24, 2001
PubMed

Insights

Unexplained chest pain (UCP) affects many patients with normal coronary angiograms. Gastroesophageal reflux disease is a common cause, best diagnosed with 24-h pH monitoring and treated with acid suppression.

Area of Science:

  • Gastroenterology
  • Cardiology
  • Internal Medicine

Background:

  • Coronary angiography reveals non-significant coronary artery disease in approximately 30% of patients presenting with chest pain.
  • These patients are diagnosed with noncardiac or unexplained chest pain (UCP), experiencing significant morbidity and healthcare costs despite a generally good prognosis.
  • The pathophysiology of UCP is complex, involving potential cardiac, esophageal, and psychiatric factors, with visceral hyperalgesia playing a key role.

Purpose of the Study:

  • To investigate the role of esophageal disorders in unexplained chest pain (UCP).
  • To evaluate diagnostic and management strategies for UCP patients.
  • To differentiate between cardiac and esophageal etiologies of UCP.

Main Methods:

  • Review of clinical symptoms and diagnostic tests for UCP.
  • Focus on the prevalence of gastroesophageal reflux disease (GERD) versus esophageal motility disorders in UCP patients.
  • Evaluation of 24-h pH monitoring as a diagnostic tool.
  • Assessment of empiric high-dose acid suppression therapy.

Main Results:

  • Clinical symptoms are often unreliable for distinguishing cardiac from esophageal causes of UCP.
  • Gastroesophageal reflux disease is identified as the most common esophageal disorder associated with UCP, more so than esophageal motility disorders.
  • Twenty-four-hour pH monitoring is deemed the most useful diagnostic test for UCP evaluation.

Conclusions:

  • Gastroesophageal reflux disease is a primary contributor to unexplained chest pain (UCP) in patients with normal coronary angiograms.
  • High-dose acid suppression therapy represents the most cost-effective initial management strategy for UCP.
  • A structured clinical algorithm is proposed for the effective evaluation and treatment of unexplained chest pain.

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