The oesophagus as a cause of recurrent chest pain: which patients should be investigated and which tests should be used?

Investigations of the oesophagus were undertaken in 50 consecutive patients who presented with recurrent chest pain thought to be non-cardiac in origin after cardiological assessment. An oesophageal disorder was demonstrated in 60%, gastro-oesophageal reflux and diffuse oesophageal spasm being the two commonest entities. However, routine contrast radiology and upper gastrointestinal endoscopy revealed abnormalities in only a minority of patients. Patients with non-cardiac chest pain of uncertain origin should initially undergo endoscopy. If no major abnormalities are detected radionuclide oesophageal transit studies, oesophageal manometry, and ambulatory monitoring of oesophageal pH should be carried out.