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Chest Pain of Esophageal Origin and Reflux Hypersensitivity

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Gastrointestinal Motility Disorders

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Abstract

The prevalence of non-cardiac chest pain in general population has been estimated as 13%. Non-cardiac chest pain might be caused by either acid reflux, esophageal motility disorders, eosinophilic esophagitis or visceral hypersensitivity (functional chest pain). After a cardiac cause of chest pain has been excluded, a short-term trial with proton pomp inhibitor (PPI) is the most cost-effective method for assessing whether non-cardiac chest pain is due to acid reflux. Upper endoscopy with biopsies of the esophagus are recommended to exclude erosive or eosinophilic esophagitis as possible causes of chest pain. In patients with persistent chest pain despite short-term PPIs trial the next step is to perform 24-h distal esophageal pH monitoring or 48-h wireless distal esophageal pH monitoring off PPI therapy to provide objective evidence whether acid reflux is present. After excluding acid reflux, the next step is to perform esophageal manometry to determine whether a major esophageal motility abnormality may be causing the chest pain such as achalasia, esophagogastric junction outflow obstruction, jackhammer esophagus, diffuse esophageal spasm, or absent peristalsis. After exclusion of acid reflux, eosinophilic esophagitis, or esophageal motility abnormality, the diagnosis of non-cardiac chest pain due to visceral hypersensitivity (functional chest pain) can be made. Treatment options of functional chest pain include theophylline, low-dose antidepressants (imipramine, trazodone, sertraline, or venlafaxine), or psychological interventions such as cognitive behavioral therapy or hypnotherapy.

This chapter discusses the epidemiology, pathophysiology, diagnosis, and management of non-cardiac chest pain.

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Authors and Affiliations

  1. Division of Digestive Diseases and Nutrition, University of South Florida Morsani College of Medicine, Tampa, FL, USA

    Wojciech Blonski M.D., Ph.D.

  2. Division of Digestive Diseases and Nutrition, Joy McCann Culverhouse Center for Swallowing Disorders, 12901 Bruce B. Downs Blvd. MDC72, Tampa, FL, 33612, USA

    Joel E. Richter M.D., F.A.C.P., M.A.C.G.

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  1. Wojciech Blonski M.D., Ph.D.
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  2. Joel E. Richter M.D., F.A.C.P., M.A.C.G.
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Correspondence to Joel E. Richter M.D., F.A.C.P., M.A.C.G. .

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Editors and Affiliations

  1. Institute of Gastroenterology, Sheba medical Center, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel

    Eytan Bardan

  2. Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA

    Reza Shaker

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Blonski, W., Richter, J.E. (2018). Chest Pain of Esophageal Origin and Reflux Hypersensitivity. In: Bardan, E., Shaker, R. (eds) Gastrointestinal Motility Disorders . Springer, Cham. https://doi.org/10.1007/978-3-319-59352-4_3

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  • DOI: https://doi.org/10.1007/978-3-319-59352-4_3

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