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Chest pain of undetermined origin (CPUO)

Chest pain is a common complaint but not all chest pains are related to heart troubles. There could be non-cardiac causes also like musculoskeletal, gastrointestinal, psychological and pulmonary. Accurately diagnosing patients with chest pain of undetermined origin usually pose a challenge to clinical research and medical practitioners. However, the initial references of this clinical problem date to more than 150 years ago. Uncertainty about its patho-physiology has resulted in recognizing the ailment by various terms. Most of the times it has been suggested that unexplained chest pain is linked with an esophageal cause since the location and innervations of the esophagus are almost same as that of the heart.


Patients complain it as an angina-like pain. Doctors first exclude cardiac or musculoskeletal disorders and then identify esophagus as the source of origin of pain. However, according to several newer researches gastroesophageal reflux is assumed to be a factor for esophageal pain. Moreover, the most recent concept known as “irritable esophagus” inherently involving a comprehensive change in esophageal pain threshold is also considered to be closely related to chest pain. Not only this, there is also a possibility of altered esophageal motility caused by stress. In most patients with chest pain of undetermined origin, aberrations in esophagus are considered to be the cause of pain. Doctors may suggest ambulatory esophageal pH and pressure monitoring to define the source of chest pain.


Though the exact cause still remains a dilemma but most practitioners believe esophageal dysmotility and esophageal reflux as the primary source for chest pain of undetermined origin. It is also seen that stress and distorted mental states have an effect on chest pain of undetermined origin. Medication and stress management are the best way to deal with chest pain of undetermined origin.



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