Evaluation of Patients With Non-cardiac Chest Pain

Non-cardiac chest pain (NCCP) is defined by recurrent episodes of retrosternal chest pain in the absence of significant cardiovascular disease after a thorough cardiac evaluation. It accounts for 2-5% of all emergency department visits. Studies examining the prevalence of esophago-gastric lesions in patients with NCCP referred to gastroenterologists have found esophagitis, esophageal ulcers, hiatal hernias, gastritis, and gastric ulcers in 62% of patients. Advances in endoscopic technologies, particularly, the introduction of the wireless video-capsule (PillCam Eso) allows for the possibility of direct visualization of the upper gastrointestinal tract in the emergency department. During capsule endoscopy, a patient will swallow a pill-sized video-capsule, the wireless images of the gastrointestinal tract are transmitted to a computer. Findings of the PillCam Eso will be then compared to findings during conventional upper endoscopy.

Inclusion criteria

• age 18 to 80 years
• negative cardiac evaluation in the emergency department
• pre-established access to a primary care provider
• ability to give informed consent

Exclusion criteria

• known history of ischemic heart disease
• proton pump inhibitor therapy
• known or suspected obstructions or strictures in the gastrointestinal tract, including a history of Crohn's disease, gastrointestinal surgery other than cholecystectomy or appendectomy.
• permanent pacemakers/defibrillators or other implantable wireless devices
• known pregnancy
• unstable medical conditions
• inability to follow instructions
• active psychiatric conditions that preclude participation in the study