Pain in chest, upper abdomen an ominous sign

NEW YORK (Reuters Health) - Unexplained pain in the chest or upper gastrointestinal tract may signal an increased risk of death from alcohol-related causes, pneumonia or lung cancer, Danish researchers report.

People with these symptoms are also more likely to be hospitalized for "ischemic" heart disease - the type of heart disease caused by restricted blood flow in heart arteries, Dr. Estrid Muff Munk and colleagues from Aarhus University Hospital found.

When a patient with pain in the chest or the upper abdomen has normal results on a test called endoscopy, in which a scope is used to view the inside of the esophagus and the stomach, the pain may be due to undiagnosed ischemic heart disease, the researchers note.

But studies to date involving patients with this type of pain and normal upper endoscopy results have not excluded those with gastroesophageal reflux disease (GERD) or ulcers, they add. "Thus, it is uncertain whether all study subjects had truly unexplained pain."

To address this issue, researchers looked at heart disease risk and death over a 10-year period in 386 patients with pain in the chest or upper abdomen, normal upper endoscopy and no existing heart disease, and 3,793 control patients. They excluded patients with reflux, heartburn or other symptoms of GERD or ulcers.

The patients with unexplained pain were 60 percent more likely to be hospitalized over the next 10 years. They also were more than twice as likely to die within the first year of their endoscopy, while mortality risk was elevated for up to five years after the test.

Their risk of death from alcohol dependence, pneumonia or lung cancer was triple that of the general population.

Unexplained chest pain and upper abdominal pain in patients with a normal endoscopy test "is a strong marker for ischemic heart disease and increased mortality," they conclude.

SOURCE: BMC Gastroenterology, published online July 15, 2008.