Chest Pain: Could it Be a GI Condition?

When experiencing chest pain, at first you might think that you’re suffering a heart attack or something else cardiac related. That’s a logical response and should be investigated as soon as possible by a physician (in the hospital’s emergency department) to rule out a heart attack. Don’t wait: Call 9-1-1 if you have chest pain to be seen by a physician immediately.

But if a heart attack is not behind your chest pain, you actually might be experiencing a gastroenterological (GI) condition. It’s not uncommon either. In fact, about 70 million people in the U.S. experience this type of chest pain, according to information from the American College of Gastroenterology (ACG).

Called noncardiac chest pain (NCCP), it is the name for chest pain that is not related to heart disease. The reason the pain can feel similar to a heart attack is because the heart and the esophagus are close to each other and share the same nerve network.

Symptoms You Might Feel

What does noncardiac chest pain feel like? The ACG states that symptoms of noncardiac chest pain may:

• Be felt behind your breastbone
• Feel like squeezing or pressure
• Extend to your neck, left arm, or back
• Be caused by eating or drinking
• Last from a few seconds or minutes to many hours
• Have other symptoms that come with it such as heartburn or regurgitation

“We see patients with noncardiac chest pain often,” says Mayurathan Kesavan, MD, gastroenterologist with Doylestown Health Gastroenterology. “Usually patients come to us after they’ve had cardiac issues ruled out because their physicians will then suggest we rule out a GI condition as well.”

Causes of NCCP

The most common cause of noncardiac chest pain is gastroesophageal reflux disease (GERD), also known as acid reflux. "GERD usually produces heartburn or regurgitation with chest pain but not always," says Dr. Kesavan. "The heartburn can mimic heart pain, or if there’s no heartburn accompanying it, the condition can still feel like heart pain with some patients," he adds.

Other causes of noncardiac chest pain can include, but are not limited to:

• Motility (esophagus muscle movement) disorders like achalasia and distal esophageal spasm
• Esophageal injuries like caustic ingestion (ingesting harmful or corrosive substances)
• Pill-induced esophagitis (inflammation of the esophagus after taking medication)
• Therapeutic endoscopy maneuvers (having an endoscopy treatment for varices or Barrett’s esophagus)
• Radiation (for cancer treatment)
• Infections including cytomegalovirus (CMV), herpes simplex virus (HSV), and human immunodeficiency virus (HIV)
• Functional chest pain (chest pain after cardiac and gastrointestinal causes have been ruled out and can often have a psychological aspect to it)

Evaluation of NCCP

Dr. Kesavan says that whenever he’s evaluating a patient, he looks for alarm signs and symptoms like difficulty swallowing or any bleeding in the GI system as well as weight loss. If he finds any of these, he will order an endoscopic evaluation. Endoscopy is a test that involves a camera attached to a long tube inserted into the esophagus, stomach, and the beginning of the small intestine to explore signs of disease.

If the endoscopy is normal, then he will typically refer the patient for functional disorder testing for motility (muscle movement) issues like pH impedance monitoring or manometry that can be performed at Doylestown Health Gastroenterology.

Treatment Available

Depending on the symptoms that accompany the chest pain, treatment often includes medication. For GERD, proton pump inhibitors (PPIs) are commonly prescribed to reduce acid. Patients take the medication anywhere from a couple of weeks to two months to see if it helps. Most patients — about 80% — get better with a trial of PPIs, according to the ACG. If their chest pain improves, the medication may or may not be continued. If the patient doesn’t get better, then further testing with endoscopy will typically be performed.

Also, low doses of tricyclic antidepressants that can help block pain signals can be useful for noncardiac functional chest pain, especially if there is a psychological component to it, says Dr. Kesavan.

• For more information and to meet with one of our Doylestown Health Gastroenterology physicians, call 215.345.6050.