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Editor's Correspondence
February 11, 2002

Functional Chest Pain of Presumed Esophageal Origin

Arch Intern Med. 2002;162(3):365. doi:

We read with great interest the recent article, "Evaluation of Patients With Chest Pain and Normal Coronary Angiograms" by Schwartz and Bourassa.1 The article gives a comprehensive review on the pathophysiologic features and the investigational workup of these patients. However, some points regarding chest pain of presumed esophageal origin need to be emphasized. When discussing the causes for esophageal pain, the authors mentioned reflux esophagitis, esophageal motility disorders, long-duration contractions, and hernia incarceration. However, in the majority of these patients complete investigation fails to reveal any significant anatomical, morphological, or biochemical abnormalities. These symptoms may then fall into the category of functional esophageal disorders.2 The diagnosis of functional esophageal disorder is based on clinical (symptom-based) criteria that were recently developed by a multinational working team also known as the "Rome criteria." For functional chest pain of presumed esophageal origin (a term used by the Rome committees), these include chronic complains of (1) midline chest pain or discomfort that is not of burning quality; and (2) absence of pathologic gastroesophageal reflux, achalasia, or other motility disorder with a recognized pathologic basis. The physiological mechanisms underlying these symptoms are still poorly understood. It is currently presumed that a combination of physiological and psychological factors contributes to the generation and severity of these symptoms.

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