When a patient presents with anginalike
chest pain, the first objective is to rule out
heart disease. Once cardiac problems have been ruled out, the second objective is to determine whether the history and/or symptoms suggest an esophageal abnormality. The diagnosis of
gastroesophageal reflux-associated
chest pain can occasionally be made from
barium radiographic or endoscopic findings. A series of additional esophageal tests--motility studies, Bernstein test,
edrophonium test, and balloon distention test--may be performed to help ascertain whether the
pain stems from the esophagus. Reassurance should precede specific
drug therapy. If any of the test results suggest
gastroesophageal reflux, a trial of
therapy for this indication, eg, a histamine2 receptor blocker, should be initiated. An
esophageal motility disorder may be treated with an
anticholinergic agent, nitro-glycerinlike product, or mild tranquilizer. If necessary, use of a
calcium channel blocker may be appropriate.