Chest pain and gastroesophageal reflux disease.

Gastroesophageal reflux disease (GERD) is the most common gastrointestinal cause of "noncardiac chest pain." Following exclusion of a cardiac cause of chest pain, an evaluation of the esophagus is, therefore, appropriate. Barium studies, endoscopy, and esophageal manometry have little value in the diagnosis of GERD-induced chest pain. Twenty-four-hour pH monitoring with a symptom-index correction may define an association but does not prove causality between the patient's chest pain and GERD. Recent studies have implied that high-dose proton pump inhibitor (PPI) therapy for one week is an effective approach. The PPI test has excellent sensitivity/ specificity and economic savings (due to reduction in diagnostic procedures) and, accordingly, should be the diagnostic/ therapeutic approach of choice for patients with suspected GERD-induced chest pain.