Of pts presenting with chest pain, 30% have an esophageal source rather than angina. History and physical examination often cannot distinguish cardiac from noncardiac pain. Exclude cardiac disease first. Causes include the following: gastroesophageal reflux disease, esophageal motility disorders, peptic ulcer disease, gallstones, psychiatric disease (anxiety, panic attacks, depression).
Consider a trial of antireflux therapy (omeprazole); if no response, 24-h ambulatory luminal pH monitoring; if negative, esophageal manometry may show motor disorder. Trial of imipramine, 50 mg PO qhs, may be worthwhile. Consider psychiatric evaluation in selected cases.