Non-cardiac, non-oesophageal chest pain: the relevance of psychological factors

Abstract

Background: No cause has been determined for chest pain that is neither cardiac nor oesophageal in origin.

Aims: To compare the prevalence of life-time psychiatric disorders and current psychological distress in three consecutive series of patients with chronic chest or abdominal pain.

Patients: Thirty nine patients with non-cardiac chest pain and no abnormality on oesophagogastroduodenoscopy, oesophageal manometry, and 24 hour pH monitoring; 22 patients with non-cardiac chest pain having endoscopic abnormality, oesophageal dysmotility, and/or pathological reflux; and 36 patients with biliary colic.

Methods: The Diagnostic Interview Schedule and the 28 item General Health Questionnaire were administered to all patients.

Results: Patients with non-cardiac chest pain and no upper gastrointestinal disease had a higher proportion of panic disorder (15%), obsessive-compulsive disorder (21%), and major depressive episodes (28%) than patients with gallstone disease (0%, p < 0.02; 3%, p < 0.02; and 8%, p < 0.05, respectively). In contrast, there were no differences between patients with non-cardiac chest pain and upper gastrointestinal disease and patients with gallstone disease in any of the DSM-111 defined lifetime psychiatric diagnoses. Using the General Health Questionnaire, 49% of patients with non-cardiac chest pain without upper gastrointestinal disease scored above the cut off point (that is, more than 4), which was considered indicative of non-psychotic psychiatric disturbance, whereas only 14% of patients with gallstones did so (p < 0.005). The proportions of such cases were however similar between patients with non-cardiac chest pain and upper gastrointestinal disease (27%) and patients with gallstones.

Conclusions: Psychological factors may play a role in the pathogenesis of chest pain that is neither cardiac nor oesophagogastric in origin.