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The treatment and evaluation of chest pain (CP) is one of the most frequently encountered emergent clinical scenarios comprising 5.7% of all emergency visits [4]. Recent estimates suggest that in the US, the costs are $10 billion annually, with only 10% of these patients ultimately having acute coronary syndrome or other diagnosis requiring admission [2]. Shockingly, these staggering costs already represent a significant improvement in the utilization of resources, as admissions for CP have decreased from 21% in 2006 to 11.8% in 2013, reflecting nearly $8 billion in estimated savings [5].

Importantly, there are some differences between inpatient and outpatient evaluation of CP, related mostly to the proportion of patients presenting with NCCP. Whereas studies in the emergency department found NCCP represents about 50% of the cases, in the outpatient setting, causes represent 70–80% of cases [6, 7]. In the outpatient evaluation of CP, the main causes are musculoskeletal (33%), gastrointestinal (10–20%), cardiac (stable angina or acute myocardial ischemia) (12–14%), and respiratory (5%) [8–12]. Recognizably, these complaints must be taken seriously, as life‐threatening causes of chest pain may be identified in 5.5–8.4% of patients [12, 13].

Gastroenterologists play an essential role in the evaluation of NCCP, as nearly 10–20% of patients will present with GI causes of CP, the majority of which are esophageal in origin [3]. Esophageal CP is common, with population‐based surveys estimating an annual prevalence of 19–33% with only mild geographic variation (China 19%, Argentina 23.5%, United States 23%, Australia 33%) [14–17]. There is a nearly equal gender distribution, but the prevalence decreases with age [14, 15]. Some studies have also found a correlation between ECP and younger age, increased alcohol and/or tobacco use, and in patients reporting anxiety [18]. This last point is especially important, as 80% of ECP patients have an overlap with a functional GI disorder, half of which were either irritable bowel syndrome (27%) or functional bloating (22%) [19]. Furthermore, 84% of patients with abnormal esophageal manometry (vs. 31% with normal) had a psychiatric diagnosis, with 25% of these patients meeting the criteria for panic disorder [20, 21].

The net effect of this disease prevalence and overlap with a number of functional and mental health disorders has significant negative adverse effects. In an analysis of patients presenting to a tertiary hospital emergency department over a one‐year period, a total of 212 patients were found to have noncardiac chest pain, which resulted in high rates of work absenteeism (29%) and interruptions to daily activities (63%) [22].