Noncardiac chest pain: evaluation and treatment

Noncardiac chest pain (NCCP) is a heterogeneous disorder that affects up to 23% of the US general population. The most common esophageal cause for NCCP is gastroesophageal reflux disease. Consequently, evaluation of patients with NCCP should always start with either a proton pump inhibitor (PPI) test or an empirical trial with high-dose PPI. The role of esophageal dysmotility in NCCP remains controversial. However, in most patients with spastic motility disorders (except achalasia) and in those with chest pain without any physiological abnormalities, pain modulators remain the cornerstone of therapy. Future progress in NCCP is likely to occur with better understanding of the underlying mechanisms of esophageal pain perception.