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Noncardiac chest pain: is the esophagus really a frequent source?

The occurrence of esophagus-related noncardiac chest pain was investigated in 22 unselected consecutive patients referred by local cardiologists. The investigations included endoscopy, standard manometry, esophageal scintigraphy, a double-blind placebo-controlled edrophonium provocation test on two occasions (during manometry and scintigraphy), an acid perfusion test, and 24-h ambulatory esophageal pH-monitoring. Nine patients had reflux symptoms; none had dysphagia. Abnormal test results were found in 11 patients. In only three of them was a definite relation between chest pain and the esophagus established: the acid perfusion test was positive in these three, as was 24-h pH-monitoring in two of them. All three had symptomatic reflux. The absence of patient selection and, possibly, the exclusion of biasing during the edrophonium tests are considered to be the most important factors for the finding of only few patients with definite esophagus-related noncardiac chest pain in this study. A prudent approach towards patients with noncardiac chest pain, with regard to the evaluation of an esophageal cause, is recommended.