Non-cardiac, non-oesophageal chest pain: the relevance of psychological factors.
BACKGROUND
No cause has been determined for chest pain that is neither cardiac nor oesophageal in origin.


OBJECTIVE
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.


METHODS
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.
Department of Medicine, National University Hospital, Singapore.
K Y
KY
Ho
J Y
JY
Kang
B
B
Yeo
W L
WL
Ng
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000150:complications; D002637:Chest Pain / Q000523:psychology*; D002769:Cholelithiasis / Q000523:psychology; D003863:Depression / Q000150:complications; D004935:Esophageal Diseases / Q000523:psychology; D005260:Female; D005764:Gastroesophageal Reflux / Q000523:psychology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008365:Manometry; D001523:Mental Disorders / Q000150:complications*; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications