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The esophageal chest pain. An update for clinicians
M Durazzo1, A Premoli, R Pellicano
1Department of Internal Medicine, University of Turin, Turin, Italy.
Insights
Gastroesophageal reflux disease (GERD) and esophageal dysmotility are key causes of non-cardiac chest pain, often overlooked by standard tests. Further research is needed to fully understand their role in chest pain pathogenesis.
Area of Science:
- Gastroenterology
- Cardiology
Background:
- Chest pain is a common symptom with significant economic impact, even with minor coronary artery disease.
- Gastroesophageal reflux disease (GERD) and esophageal dysmotility are implicated in non-cardiac chest pain, but mechanisms are unclear.
- Standard diagnostic tools like endoscopy are often unrevealing for non-cardiac chest pain.
Purpose of the Study:
- To investigate the role of esophageal disorders in the genesis of non-cardiac chest pain.
- To clarify the diagnostic utility of various methods in identifying esophageal causes of chest pain.
- To highlight the need for further research into the pathogenesis of non-cardiac chest pain.
Main Methods:
- Aggressive trial of high-dose antisecretory drugs.
- Prolonged ambulatory pH monitoring.
- Esophageal manometry with provocative testing for motility abnormalities and sensitivity.
Main Results:
- Esophageal origin of chest pain can be identified through specific diagnostic trials.
- Endoscopy is less useful than for heartburn, often showing normal results.
- Manometry aids in evaluating patients without GERD, identifying esophageal motility issues.
Conclusions:
- Esophageal disorders are important considerations in patients with non-cardiac chest pain of unknown origin.
- High-dose acid suppression and pH monitoring can help diagnose GERD-related chest pain.
- Further research is essential to elucidate the precise role of esophageal disorders in chest pain pathogenesis.
Abstract:
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.