Is My Esophagus Causing Chest Pain:?

Gastroenterologists see patients for chest pain regularly.  This is because the esophagus is a potential origin of various chest symptoms.  We all know that heartburn and belching, for example, can be manifestations of gastroesophageal reflux disease, or GERD.   But the esophagus is not always the culprit responsible for chest distress!

When I am seeing a patient with chest pain, my highest professional obligation is to consider if there might be a cardiac explanation.  If I am at all suspicious, then I will direct the patient to an appropriate practitioner, which may be the primary physician.  Years ago, I sent a patient with chest pain directly to the emergency room.  From there, he was sent for cardiac catheterization when a stent was placed..  Nearly every doctor could relate a similar anecdote.

Oftentimes, chest pain patients are sent to me by cardiologists so I can be secure that a cardiac explanation has been excluded,  On other occasions, patients are sent to GI specialists by emergency room physicians or others who have determined that the chest pain is not cardiac.  “It must be your esophagus”, these patients are told.  This is how the esophagus fuse gets lit.

Just because the heart is okay, doesn't mean the esophagus is sick.

These patients who are often given the clumsy label of non-cardiac chest pain (NCCP), are told that their esophagus is the likely cause of their chest pain.  And this makes perfect sense to the patients, some of whom come to my office wanting treatment for their ‘esophageal spasm’. 

But it’s not that simple.  Most of these individuals have no esophageal disease or condition.  Their scope exams of the esophagus are usually normal and they do not respond to medicines commonly given for esophageal disorders.   And trueesophageal spasm, when a squeezing esophagus can cause pain, is rare.

Telling a patient that the esophagus is likely innocent when he has been told that  it is the offender can lead to an interesting conversation with a bewildered patient.

There can be an element of mystery about the cause of chest pain or pain elsewhere. In one example, we are now aware that there are individuals who suffer ‘heartburn’ but do not have true GERD. They do not have excessive acid in the esophagus. This is why conventional heartburn medicines to not relieve their condition which is called functional heartburn. 

So what are all of these chest pain patients suffering?  I don’t know.  But just because the heart has been deemed innocent does not meant that the esophagus is guilty.  Perhaps, we gastroenterologists should take a lesson from our cardiology colleagues and label these patients as having non-esophageal chest pain (NECP).

To be fair, there are certainly patients with chest symptoms who are found to have e3sophageal disease.  But there remains a group of them with no explanatory diagnosis.

Perhaps, with medical progress, we will discover esophageal explanations for some of these suffering patients..  But for now, the terrain remains quite murky and frustrating.

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