Chest pain of esophageal origin

Chest pain is a cause of significant anxiety in a patient. Even those who have no evidence of cardiac disease may have many visits to the emergency department and even repeated hospitalizations because of chest pain. Atypical chest pain is now the commonest reason for patients to be referred for esophageal manometry studies. The development of provocative studies has led both to an increased demonstration of esophageal origin of chest pain, as well as an increased awareness of the complexity of the esophageal response to a variety of stimuli. The possibility of a generalized smooth muscle disorder has been considered on the basis of studies demonstrating that many patients with microvascular angina have esophageal motor disorders. This review examines some of the issues related to the use of provocative agents to study patients with chest pain, in addition to briefly reviewing gastroesophageal reflux disease and esophageal mucosal disorders.