Changing Focus on Unexplained Esophageal Chest Pain
Authors: Raj K. Goyal
Journal: Annals of Internal Medicine (1996)

Editorials1 June 1996Changing Focus on Unexplained Esophageal Chest PainRaj K. Goyal, MDRaj K. Goyal, MDDepartment of Veterans Affairs Medical Center, West Roxbury, MA 02132Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-124-11-199606010-00010 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In this issue, two articles [1, 2] address aspects of esophageal chest pain, including the importance of reflux esophagitis, esophageal motility disorders, and esophageal sensory disorder in noncardiac chest pain.Coronary artery disease and reflux esophagitis are common clinical disorders [3]. In their classic presentations, coronary ischemia with exertional angina and reflux esophagitis with heartburn and acid regurgitation can be easily diagnosed. However, the pain in these two disorders is usually atypical. Because coronary artery disease is so serious, patients who have atypical chest pain are first evaluated for this disorder. Patients with strong indications of coronary artery disease (exertional ...References1. Frobert O, Funch-Jensen P, Bagger JP. Diagnostic value of esophageal studies in patients with angina-like chest pain and normal coronary angiograms. Ann Intern Med. 1996; 124:959-69. Google Scholar2. Rao SS, Gregersen H, Hayek B, Summers RW, Christensen J. Unexplained chest pain: the hypersensitive, hyperreactive, and poorly compliant esophagus. Ann Intern Med. 1996; 124:950-8. Google Scholar3. Castell DO. Chest pain of undetermined origin: overview of pathophysiology. Am J Med. 1992; 92:2S-4S. Google Scholar4. Vantrappan G, Janssens J, Ghillebert G. The irritable oesophagus—a frequent cause of angina-like pain. Lancet. 1987; 1:1232-4. Google Scholar5. Breumelhof R, Nadorp JH, Akkermans LM, Smout AJ. 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Differential sensitivity to bradykinin of esophageal distention-sensitive mechanoreceptors in vagal and sympathetic afferents of the opossum. J Neurophysiol. 1992; 68:1053-67. Google Scholar19. Cervero F, Janig F. Visceral nociceptors: a new world order? Trends Neurosci. 1992; 15:374-8. Google Scholar20. Mayer EA, Gebhart GF. Basic and clinical aspects of visceral hyperalgesia. Gastroenterology. 1994; 107:271-93. Google Scholar21. Jones AK, Derbyshire SW. Positron emission tomography as a tool for understanding the cerebral processing of pain. In: Boivie J, Hansson P, Lindblom U, eds. Touch, Temperature, and Pain in Health and Disease: Mechanisms and Assessments. Seattle, WA: IASP Pr; 1994:491-520. Google Scholar22. Beitman BD, Mukerji V, Lamberti JW, Schmid L, DeRosear L, Kushner M, et al. Panic disorder in patients with chest pain and angiographically normal coronary arteries. Am J Cardiol. 1989; 63:1399-403. Google Scholar Author, Article, and Disclosure InformationAffiliations: Department of Veterans Affairs Medical Center, West Roxbury, MA 02132Acknowledgments: The author thanks Donna Kantarges and Lisa Underhill for help with manuscript preparation.Grant Support: By grant DK 31092 from the National Institutes of Health.Corresponding Author: Raj K. Goyal, MD, Research and Development Service (151), Department of Veterans Affairs Medical Center, 1400 VFW Parkway, West Roxbury, MA 02132. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoSilent Ischemia as a Central Problem: Regional Brain Activation Compared in Silent and Painful Myocardial Ischemia Stuart D. Rosen , Eraldo Paulesu , Petros Nihoyannopoulos , Dimitris Tousoulis , Richard S.J. Frackowiak , Christopher D. Frith , Terry Jones , and Paolo G. Camici Unexplained Chest Pain: The Hypersensitive, Hyperreactive, and Poorly Compliant Esophagus Satish S.C. Rao , Hans Gregersen , Bernard Hayek , Robert W. Summers , and James Christensen Diagnostic Value of Esophageal Studies in Patients with Angina-like Chest Pain and Normal Coronary Angiograms Ole Frobert , Peter Funch-Jensen , and Jens Peder Bagger Match and Mismatch: Identifying the Neuronal Determinants of Pain Kenneth L. Casey Metrics Cited bySymptoms and diagnosis of myocardial infarctionEmergency Department and Office-Based Evaluation of Patients With Chest PainNutzen und Risiko von Nitropräparaten bei Angina-pectoris-BeschwerdenChanges in the Numeric Descriptive Scale for Pain After Sublingual Nitroglycerin Do Not Predict Cardiac Etiology of Chest PainChest Pain Relief by Nitroglycerin Does Not Predict Active Coronary Artery DiseaseCharles A. Henrikson, MD, MPH, Eric E. Howell, MD, David E. Bush, MD, J. Shawn Miles, MD, Glenn R. Meininger, MD, Tracy Friedlander, Andrew C. Bushnell, MD, and Nisha Chandra-Strobos, MDEffectiveness of a multidisciplinary chest pain unit for the assessment of coronary syndromes and risk stratification in the Florence areaNoncardiac Chest PainA Critical Approach To Noncardiac Chest Pain: Pathophysiology, Diagnosis, and TreatmentEvaluation of the Patient with Nontraumatic Chest PainDolores tor?cicosClinical Manifestations, Natural History and Differential Diagnosis of Reflux EsophagitisEvaluation of the Patient with Acute Chest PainCHEST PAIN IN PEDIATRICSEsophageal Chest PainIs there a pathologic basis for gastrointestinal dysmotilityEvaluation of chest pain in the emergency department 1 June 1996Volume 124, Issue 11Page: 1008-1011KeywordsAngiographyDysphagiaEsophagusIschemiaMusclesMyalgiaNervesNociceptorsStable coronary artery diseaseThorax Issue Published: 1 June 1996 Copyright & PermissionsCopyright © 1996 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...