Esophageal perception and noncardiac chest pain

Noncardiac chest pain (NCCP) is a symptom complex that, in its broadest context, includes patients with heartburn, odynophagia, and pleurisy. In most instances, patients with these complaints are readily diagnosed and treated successfully for the underlying disease (eg, reflux esophagitis, infectious or pill-induced esophagitis, or upper respiratory infection). Nonetheless, a significant number of patients remain with undiagnosed NCCP. Typically these patients complain of pain that resembles angina or heartburn. In most instances, the source for the NCCP is believed to emanate from the esophagus. Why this is so speaks to the location of the organ, its repertoire of responses to noxious stimuli, and the complexity of the neuroanatomic pathways that enable pain perception. These areas are the subjects of this article.