Esophageal chest pain: current controversies in pathogenesis, diagnosis, and therapy

To evaluate the importance of esophageal abnormalities as a potential cause of recurrent noncardiac chest pain.

We discuss the rapidly evolving new knowledge in this field after analyzing the literature in English published since 1979.

We reviewed 117 articles on recurring chest pain and paid specific attention to the following nine controversial issues: the potential mechanisms of esophageal pain, the differentiation of cardiac and esophageal causes, the evaluation of new esophageal motility disorders, the use of esophageal tests in evaluating noncardiac chest pain, the usefulness of techniques for prolonged monitoring of intraesophageal pressure and pH, the relation of psychologic abnormalities to esophageal motility disorders, the possible mechanisms for decreased visceral pain thresholds in these patients, the relation of esophageal chest pain to the irritable bowel syndrome, and the appropriate therapies for these patients.

Through our review of the literature, we identified areas of concordance and disagreement. These areas are discussed and an overall perspective is provided.

Continuing attempts to develop rational diagnostic and therapeutic approaches to patients with noncardiac chest pain should include a multidisciplinary approach involving basic scientists, gastroenterologists, psychologists, and other clinical experts in the field of pain research.