["Esophageal" angina and angina pectoris]

Area of Science:

• Gastroenterology
• Cardiology
• Psychology

Context:

• Non-cardiac chest pain affects numerous patients and specialists, involving complex socio-economic, pathophysiological, and therapeutic issues.
• A significant number of patients with normal coronary arteriography experience persistent chest pain, leading to repeated cardiac evaluations and fear of myocardial infarction.
• The esophagus is recognized as a potential source of chest pain in patients with a prior diagnosis of 'atypical' angina pectoris.

Purpose:

• To explore the challenges in diagnosing the origin of non-cardiac angina-like chest pain.
• To highlight the limitations of current diagnostic methods for esophageal angina.
• To address the diagnostic gap for patients with unexplained chest pain.

Summary:

• Esophageal angina is associated with angina pectoris, and treatments like calcium antagonists and nitroderivatives have been used.
• Provocative and spontaneous tests for esophageal pain provide only likely, not definite, diagnoses, with no established gold standard test.
• A likely diagnosis of esophageal angina is achieved in only about 50% of patients, leaving the cause for the remaining half undetermined.
• Psychological factors, such as panic disorder, are proposed as alternative explanations for chest pain when esophageal origins are not definitively identified.

Impact:

• Highlights the diagnostic uncertainty surrounding non-cardiac chest pain, impacting patient care and healthcare resource utilization.
• Underscores the need for improved diagnostic tools and strategies for esophageal angina.
• Emphasizes the multidisciplinary approach required to manage patients with unexplained chest pain, considering both organic and psychological factors.