Esophageal cause of Chest Pain

Diagnosis of exclusion — only consider GERD if:

• Coronary disease unlikely by risk factor analysis; OR
• Chronology & Duration not compatible with angina / infarction, AND
• Pain isn’t associated with exertion.

Think of GERD if chest pain:

• occurs after swallowing
• supine in bed
• lasts hours
• accompanied by heartburn, acid regurgitation, or dysphagia
• if persistent dysphagia, must scope to R/O cancer)

Consider therapeutic (i.e. diagnostic) trial of high-dose PPI for 2 weeks.

• If successful, decrease to standard dose
• If no help, discontinue

See posting Chest Pain – 3.