Does GERD play a role in chronic chest pain

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There are many causes of chest pain because many structures "live" in the chest. The chest wall, the muscles, ribs, and cartilage can cause pain. Chest pain may be related to the heart or lungs or the esophagus. The types and character of the discomfort related to these organs are generally different but can be quite similar in some individuals. Sometimes it can be very difficult to tell whether the chest pain a patient is experiencing is a heart attack or just heartburn. Because of this have a doctor immediately evaluate any chest pain or discomfort. Heart attacks can be treated, and patients absolutely need to be evaluated for the presence of impaired blood flow to the heart. This can be a matter of life and death. That said, if you have chest pain or discomfort, have been evaluated by a doctor, and have had heart problems tested for and ruled out, then GERD may be the issue. This is called noncardiac ("not heart") chest pain.

Symptoms of esophageal chest pain are pain after a meal, pain after drinking very cold liquids, pain associated with difficulty swallowing, or pain improved with antacid medications. If this is the case, a trial of medication such as a high-dose proton pump inhibitor

Sometimes it can be very difficult to tell whether the chest pain a patient is experiencing is a heart attack or just heartburn. Because ofthis have a doctor immediately evaluate any chest pain or discomfort.

should be tried, for example, omeprazole 20 milligrams twice a day. If there is improvement of symptoms, this suggests that there may be an esophageal cause for the chest pain.

Alternatively, if there is no change or minimal improvement, other tests can be done. Acid or pH testing is abnormal in approximately 60% of those with noncardiac chest pain, suggesting GERD as a cause of the pain. Esophageal motility testing (see Question 68) may be helpful. This test can diagnose muscle spasms in the esophagus, which feel like severe, crushing chest pain that can last for minutes and feel like a heart attack. Different substances can be dripped into the esophagus during the testing to see whether the chest pain symptoms can be provoked or caused. An example, called a Bernstein test, is when acid (like stomach acid) is infused into the esophagus during a motility test. This allows for pressure measurement in the esophagus to see if muscle spasms occur and the patient can subjectively tell the tester whether he or she is having chest pain during the acid challenge.

As mentioned, treatment for noncardiac chest pain first is a high-dose proton pump inhibitor (PPI) antacid. If this fails, you can try another PPI or other drugs such as muscle relaxers or even some antidepressant medications.

Richard's comment:

I do not have chronic chest pain or many of the other serious side effects of acid reflux. Having become familiar with these terrible symptoms (i.e., chronic coughing, difficulty swallowing food, Barrett's esophagus, chronic heartburn, larynx problems), I am determined to control my acid reflux with smart lifestyle changes.

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