CHEST PAIN OF ESOPHAGEAL ORIGIN

One third to one half of patients presenting with chest pain have no e vidence of coronary artery disease and are characterized as having non -cardiac chest pain. in a large subset of these patients, the esophagu s can be the source of the symptoms. This paper summarizes recent prog ress in our understanding of chest pain of esophageal origin. The valu e of esophageal diagnostic evaluation in patients with chest pain and normal coronary arteries remains controversial. Symptomatic gastroesop hageal reflux is the most common cause of chest pain of esophageal ori gin. The use of impedance planimetry has provided a better insight in the mechanisms underlying hypersensitivity to esophageal balloon diste nsion. The high prevalence and likely role of panic disorder in patien ts with chest pain of non-cardiac origin has been confirmed. Further i nvestigations towards factors underlying atypical chest pain should in clude not only a gastrointestinal but also a psychological work-up. Fi nally, recent reports indicate the contribution of the esophagus to ch est pain events in patients with known coronary artery disease.