Approach to managing undiagnosed chest pain: could gastroesophageal reflux disease be the cause?

OBJECTIVE

To highlight gastroesophageal reflux disease as a common cause of undiagnosed chest pain.

SOURCES OF INFORMATION

Diagnostic considerations are based on information in peer-reviewed articles retrieved from MEDLINE. Studies had to be in English and involve at least 30 subjects. Population-based studies had to have a sample size of at least 300 and a response rate of at least 60%. Thirty-seven relevant articles were found.

MAIN MESSAGE

Clinical management of patients presenting with diagnostically challenging chest pain starts with a careful search for coronary artery disease and other potentially life-threatening causes. Investigations must continue until the underlying disease is identified and symptoms have been effectively controlled. Ongoing symptoms of undiagnosed chest pain cause considerable suffering, impair quality of life, and add unnecessary costs to the health care system. In more than half the patients with undiagnosed chest pain, symptoms are caused by gastroesophageal disease. Empirical acid-suppressive therapy with a proton pump inhibitor can assist clinicians in identifying patients whose symptoms are acid-related.

CONCLUSION

Many patients with undiagnosed chest pain can be managed in primary care, minimizing the need for referrals and costly investigations.