Clinical Review ABC of the upper gastrointestinal tract

Oesophagus: Atypical chest pain and motility disorders

BMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7316.791 (Published 06 October 2001) Cite this as: BMJ 2001;323:791
  1. John Bennett

    Chest pain has been a diagnostic problem for centuries. Heberden's superb clinical description of angina pectoris (and other chest pains) still stands, but today's doctors may be no better at diagnosing cardiac pain accurately than their predecessors 60 years ago. Even when a doctor is sure that the pain is non-cardiac, the more inquiring patient often wants a more specific label.


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    The close proximity of the heart and oesophagus mean that distinguishing oesophageal from cardiac pain is often difficult

    Much of the interest in this subject has arisen from the extensive investigation of patients concerned that their symptoms could be cardiac in origin. Given the associated and inevitable selection bias, there is little objective evidence on which to base practice, but the oesophagus is undoubtedly one of the organs that can generate problematic chest pain.

    This article describes the oesophageal disorders responsible, and ways to diagnose them. Psychological factors are often important in patients with chest pain, so that common sense, understanding a patient and his or her problem, and good communication are usually more important than diagnostic tests and powerful drugs.

    What does oesophageal pain feel like?

    Oesophageal pain has many patterns: it is often described as burning, sometimes as gripping, and it can also be pressing, boring, or stabbing. Usually in the anterior chest, it tends to be felt mainly in the throat or epigastrium and sometimes radiates to the neck, back, or upper arms—all of which may equally apply to cardiac pain. The commonest patterns of cardiac and oesophageal pains are quite different and well recognised, but perhaps 20% of each are much harder to feel confident about.

    Frequency of pain experienced in different anatomical sites by patients with cardiac pain and oesophageal pain

    Mechanisms of oesophageal pain

    Discomfort or pain from the oesophagus may arise from irritant stimuli to the mucosa or from mechanical effects on …

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