A 64-year-old woman was hospitalized with heartburn and precordial pain. Cardiovascular disease was not detected. Therefore, we investigated the gastrointestinal tract. Conventional esophageal manometry and upper gastrointestinal series were normal. On endoscopy, columnar epithelium of approximately 1 cm was found around the circumference of the lower esophagus, but there was no acute reflux esophagitis. On Bernstein test, heartburn appeared, but precordial pain did not occur. On esophageal balloon dilatation, there was a sense of pressure, but precordial pain did not occur. Because heartburn occurred on Bernstein test, we considered the possibility of gastroesophageal reflux (GER) disease, and investigated 4-hour intraesophageal pH monitoring. GER occurred on several occasions during the first hour of the postprandial period, and 2 episodes of GER were accompanied by heartburn. During the first hour of the postprandial period, the percent time pH<4.0 was 9.6%.
The cause of precordial pain was unclear, but the existence of GER was established. So we administered proton pump inhibitor (PPI) to confirm the diagnosis and for treatment. After oral administration of PPI, heartburn and precordial pain completely disappeared. We concluded that the cause of precordial pain in this case originated with GER.
