Chest Pain, GI Causes
From Expert System: Chest Pain
Gastrointestinal (GI) conditions of the esophagus, and stomach are the second most common cause of nonanginal chest pain, accounting for up to a third of all cases. Moreover, typical or atypical angina may themselves be confused with gastrointestinal problems. Esophageal conditions causing nonanginal chest pain include the very common diagnosis, gastroesophageal or "GE reflux" caused by stomach acid ascending to the lower esophagus, often accompanied by "hiatal hernia" and commonly described as HEARTBURN. Sometimes disorders of swallowing may be related to chest pain. Other common causes are ulcer disease and ulcer symptoms without ulcer, so-called "non-ulcer dyspepsia." Rarely, gall bladder disease causes this kind of chest pain. (See module on "Upper Abdominal Symptoms: Pain, Indigestion, or Heartburn.)
In diagnosing acid reflux, esophageal disorders, ulcer or nonulcer dyspepsia, it is the opinion of the program developers that expensive and potentially risky invasive procedures such as upper GI endoscopy, should almost never be performed before X-ray studies (esophagogram and upper GI series). These radiographic tests remain the most reliable, safest, and cheapest initial imaging procedures for studying structure and function of the upper gastrointestinal tract. In general, only with ominous or abnormal findings on X-ray examination should invasive testing, such as endoscopy, be undertaken. Most patients with simple reflux (heartburn) do not require investigation unless the symptoms are persistent, progressive, and unresponsive to treatment.
For further information about diagnosing upper gastrointestinal and esophageal conditions, see module on Upper Abdominal Symptoms, Pain, Indigestion, or Heartburn.
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