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Recurring chest pain that is not due to underlying coronary artery disease is a common presenting symptom of some esophageal diseases. The prevalence in the community has been reported to be 13% and is similar in men and women [30]. Given that the vagal afferents from the esophagus and heart converge prior to their transmission to the brain, it can be challenging to differentiate between cardiac and esophageal chest pain. While concomitant pain with exertion, shortness of breath, and arm or jaw pain point to a cardiac etiology, and while pain upon eating a meal, heartburn, or regurgitation is more suggestive of an esophageal etiology, one cannot make a definitive diagnosis based on these characteristics alone. It is for these reasons that formal evaluation for a cardiac or life‐threatening etiology is mandatory.

Once a cardiac etiology has been excluded, it is then important to assess for an esophageal etiology, as esophageal diseases account for the majority of noncardiac chest pain [31]. The initial patient assessment should include a medication review for any medications known to cause esophageal injury and pill esophagitis. Among esophageal etiologies of chest pain, GERD is the most common cause, as upwards of 50% of noncardiac chest pain patients have abnormal esophageal acid exposure [32, 33]. Patients with esophageal motility disorders such as achalasia or jackhammer esophagus often describe retrosternal chest pain, along with dysphagia.

While assessing a patient for an esophageal etiology, it is also important to consider other noncardiac, non‐esophageal sources of chest pain such as musculoskeletal disorders (costochondritis), psychiatric disorders, and functional chest pain. The evaluation and management of noncardiac chest pain are discussed in Chapter 2.