Noncardiac chest pain is a vexing diagnostic problem. Recently, awareness of the potential for the esophagus to cause chest pain is increasing, But a causal relationship between esopha- geal motility or reflux disease and chest pain may be difficult to prove. We perform this study to evaluate the importance of esophageal abnormalities as a potential cause of recurrent noncardiac chest pain. We underwent endoscopy, esophageal manometry with edrophonium provocation test and 24hour esophageal pH monitoring in 54 patients with normal coronary arteriogram and negative vascular spasm studv. Eighteen patients (33%) had abnormal esophgeal manometry test and in 15 patients, the chest pain could be provocated with edrophonium injection (80,u g/kg). But only 6 patients (II %) showed positive edrophonium provocation test and abnormal motilty test. These were 3 cases of diffuse esophgeal spasm, I case of nutcracker esophagus and 2 cases of hypertensive lower esophageal sphincter(LES). In twenty eight patients with 24hour pH monitoring, 9 pa- tients (32.1 %) had pathologic reflux and 1 9 patients experienced chest pain during test time. Ten patients out of 1 9 patients had positive symptom index (S.I,) and 6 patients (31.6%) had both pathologic reflux and pisitive S.I.. Mean S.I. Of these 6 patients was 65.5% (range 50- 1 00%). In conclusion, about 40% of patients with noncardiac chest pain had esophageal disease as probable cause of chest pain and gastroescphai,,cal, reflux disease as well as esophageal motili- ty disease was important cause of chest pain even if without evidence of reflux esophagitis. (Korean J Gastroenterol 1994; 26 : 1-8)