Unexplained (noncardiac) chest pain: Article five in the series Report uri icon


MeSH Major

  • Adenoma
  • Colonography, Computed Tomographic
  • Colorectal Neoplasms


  • Unexplained chest pain is a common problem in clinical practice. Even after coronary artery disease has been ruled out and the patient reassured of the non-life-threatening nature of his or her condition, morbidity and decreased quality of life persist, at considerable economic and social cost. Awareness of an esophageal etiology, present in more than 60% of these patients, can lead to improvement as well as reassurance. Gastroesophageal reflux can be diagnosed in up to 50% of cases and successfully treated. Up to 25% to 30% of patients will have an esophageal motility disorder, often with high-amplitude esophageal peristaltic contractions (nutcracker esophagus). In 20% to 30%, pain will be elicited by provocative agents, suggesting a hypersensitive (or irritable) esophagus. A systematic approach to diagnosis, using ambulatory pH monitoring and esophageal motility testing, as well as provocative tests, will allow the physician to develop a logical and successful treatment plan for this complex group of patients. This article reviews the epidemiology, differential diagnosis, and management of unexplained chest pain in patients with normal coronary arteries.

publication date

  • January 1997



  • Report

Additional Document Info

start page

  • 26

end page

  • 30


  • 21


  • 8