[Approach to the Patient with Non-cardiogenic Chest Pain of Esophageal Origin]

Non-cardiac chest pain is defined as the presence of recurrent retrosternal pain in which cardiovascular etiology has been objectively ruled out. Its overall prevalence in the community is estimated to be 13%. In this review we will focus on esophageal causes of chest pain, which rank first among non-cardiac causes. Currently available diagnostic tools to evaluate chest pain related to esophageal disorders include: therapeutic trials with proton pump inhibitors, upper gastrointestinal videoendoscopy, ambulatory reflux monitoring and high-resolution esophageal manometry. Treatment should be directed at the underlying pathophysiological mechanism responsible for the symptoms. Therapeutic options include drugs (proton pump inhibitors and neuromodulators), endoscopic treatment, surgery, and psychological therapies.