Gastroenterology Learning Network
Jun 8, 2026 · 21 min · 13 segments
Gut Check: Andree Koop, MD, on Noncardiac Chest Pain by Gastroenterology Learning Network
Andre CopeGuest
Brian LacyHost
It's something that greatly affects the quality of life of our patients and also is asso-associated with significant healthcare utilization.
And yeah, to start, how do we define non-cardiac chest pain? This is typically defined as a recurring retrosternal chest pain or discomfort of non-cardiac etiology.
It may be a stabbing or sharp pain, um, and it can vary in frequency from daily to several times per week, but typically a retrosternal pain or discomfort.
So following up on that, when we think about this retrosternal chest pain or discomfort, are there any specific descriptors that help distinguish a cardiac cause of chest pain from a non-cardiac cause of chest pain? You know, for example, is burning pain more likely to represent a non-cardiac cause as opposed to a squeezing type of pain?
Patient history and pain descriptors alone do not reliably distinguish cardiac ischemia from esophageal chest pain because both share visceral afferent innervation, and they can present similarly.
We do think about features like postprandial timing, relief with antacids or heartburn and regurgitation, and perhaps those may suggest an esophageal source, but they're not specific enough to be diagnostic, so that's really important.
Um, this is particularly important with patients with diabetes or women or older adults who may have atypical, um, sy-- or they may present with more atypical symptoms, um, as well.
So, uh, we cannot rely on history and physical examination, and this is where we rely on our objective cardiac testing, um, to rule out cardiac etiology.
It's something that greatly affects the quality of life of our patients and also is asso-associated with significant healthcare utilization.
And yeah, to start, how do we define non-cardiac chest pain? This is typically defined as a recurring retrosternal chest pain or discomfort of non-cardiac etiology.
It may be a stabbing or sharp pain, um, and it can vary in frequency from daily to several times per week, but typically a retrosternal pain or discomfort.
So following up on that, when we think about this retrosternal chest pain or discomfort, are there any specific descriptors that help distinguish a cardiac cause of chest pain from a non-cardiac cause of chest pain? You know, for example, is burning pain more likely to represent a non-cardiac cause as opposed to a squeezing type of pain?
Patient history and pain descriptors alone do not reliably distinguish cardiac ischemia from esophageal chest pain because both share visceral afferent innervation, and they can present similarly.
We do think about features like postprandial timing, relief with antacids or heartburn and regurgitation, and perhaps those may suggest an esophageal source, but they're not specific enough to be diagnostic, so that's really important.
Um, this is particularly important with patients with diabetes or women or older adults who may have atypical, um, sy-- or they may present with more atypical symptoms, um, as well.
So, uh, we cannot rely on history and physical examination, and this is where we rely on our objective cardiac testing, um, to rule out cardiac etiology.
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