Non-cardiac chest pain

Introduction Non-cardiac chest pain (henceforth referred to as NCCP) has attracted an enormous amount of both clinical and research interest in the last five years. This has been accompanied by the publication of a number of major reviews by gastroenterologists (Botoman, 2002) as well as psychiatrists and psychologists (Thurston et al ., 2001). More recently Accident and Emergency (A&E) physicians have also shown an interest in the topic (Goodacre et al ., 2002), whereas cardiologists have been more concerned with rapid access chest pain clinics (Wood, 2001). What has provoked the resurgence of interest in this topic? There are a number of possible explanations. First, the establishment of rapid access chest pain clinics in the UK has revealed that between one-half and three-quarters of patients attending these clinics do not have coronary heart disease. Second, high rates of patients with ‘undifferentiated’ or non-cardiac chest pain have been detected in chest pain observation units established both in the USA and the UK. Finally, there is evidence that these patients are not only a significant economic burden (Eslick et al ., 2002) but also that certain interventions can reduce chest pain, consultation rates and disability (Mayou et al ., 1997). In this chapter the prevalence, diagnosis, pathophysiology, economic burden and management of patients with non-cardiac chest pain will be discussed. It is important to emphasize that the cause of NCCP is often multifactorial and that eliciting the interaction between each patients' symptom experience and interpretation is a key part of the clinical interview.