Chest pain of esophageal origin

Chest pain of esophageal origin or noncardiac chest pain is reported by at least a fifth of the general population. Recent literature focused on furth er understanding mechanisms of chest pain in subset of patients with functi onal chest pain of presumed esophageal origin. Studies have demonstrated co ncurrent visceral and somatic pain hypersensitivity, and amplified secondar y allodynia, in patients with noncardiac chest pain (NCCP), suggesting cent ral sensitization. Other studies have demonstrated abnormal cerebral proces sing of intraesophageal stimuli. However, gastroesophageal reflux disease ( GERD) has remained the most common esophageal cause of NCCP. The introducti on of the proton pump inhibitor test, a highly sensitive and cost-effective diagnostic strategy, simplified our diagnostic approach toward patients wi th GERD-related NCCP. For patients with positive proton-pump-inhibitor test results, long-term treatment with antireflux medication is warranted. For patients with non-GERD-related NCCP, pain modulators remain the cornerstone of therapy.