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.