Esophageal Motility Disorders in Patients With Non-cardiac Chest Pain at Assiut University Hospital

Non-cardiac chest pain (NCCP) is defined as recurrent anginalike pain without evidence of cardiac disease [1]. NCCP is a common disorder and accounts for 14-33% of patient visits to gastroenterologists [2]. These patients frequently undergo testing for reflux and esophageal motility as gastroesophageal reflux disease (GERD) is seen in 50-60% and esophageal motility disorders in 15-18% of the patients [3,4]. Nutcracker esophagus was thought to be the classic manometric finding in NCCP [5] but other studies have reported ineffective esophageal motility (IEM) as the most common motility disorder in NCCP [6,7]. Furthermore, up to one-third of patients do not have any GERD or motility disorders and are labeled as functional chest pain [8]. Suggested causes in these patients include esophageal hypersensitivity [9], abnormal cerebral pain processing and psychological comorbidity [10]. The clinical predictors of abnormal esophageal function tests in NCCP have not been identified. Identifying these factors would lead to limited use of testing in those with risk factors and faster institution of pain modulator therapy in patients who are most likely to have functional chest pain.