Canadian Association of Gastroenterology Practice Guidelines: Management of Noncardiac Chest Pain

OVERVIEW OF THE PROBLEM From 10% to 30% of patients who undergo cardiac catheterization for chest pain are found to have normal epicardial coronary arteries (1,2). These patients are considered to have noncardiac chest pain (NCCP) and many are referred for evaluation of their upper gastrointestinal tract. By extrapolating American data, a conservative estimate for the Canadian incidence of NCCP is approximately 7000 new cases/year (3). Because many of these patient are referred to a gastroenterologist, it is imperative that the gastrointestinal consultant understand the nature of this condition and have a rational approach to its diagnosis and treatment. The objective of this document is to synthesize the available literature on the management of NCCP as it applies to practice of gastrointestinal specialists and to recommend practical guidelines for the management of this common problem.