Understanding Chest Pain After Colonoscopy : Causes, Diagnosis, and Treatment

Colonoscopy is a medical procedure in which the colon is examined using a long flexible tube called a colonoscope. A colonoscope is an instrument that is equipped with light and a small camera that allows the gastroenterologist to visualize the inner lining of the colon and rectum.

Colonoscopy plays a crucial role in screening, diagnosing, and preventing colon disease.⁽³⁾

• Colonoscopy helps in the early detection of colorectal cancer, which is the 3rd most common cancer worldwide.⁽⁵⁾ It helps in identifying the precancerous growths, which can be removed during the procedure.
• Regular colonoscopy screenings are recommended for people above 50 years of age and earlier for those with a family history of colorectal cancer.
• Colonoscopy allows detection and early removal of polyps, and abnormal tissue growths in the colon. This can be helpful in reducing the risk of developing cancer.
• Colonoscopy can help in diagnosing inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis.
• It can be helpful in diagnosing the cause of gastrointestinal symptoms as it allows direct visualization of the colon.

Colonoscopy is a safe and well-tolerated procedure and may involve preparation and sedation. However, there are potential complications, some of which include:⁽¹⁾

• Perforation or small tear in the colon wall, which may lead to abdominal pain, infection, and in severe cases may need surgical repair.
• Bleeding which in most cases is minor and resolves on its own but in rare instances may require further interventions.
• There can be an adverse reaction to sedation which can be allergic reactions, respiratory problems, and cardiovascular complications.

There can be an incomplete examination when the colonoscope does not reach the furthest part of the cecum. This can be due to anatomical variations, strictures, or patient discomfort. It is important to discuss the potential complications and side effects with a healthcare professional before undergoing a colonoscopy.

Chest pain after colonoscopy is rare but an important concern that needs to be investigated properly. It is important to evaluate the potential causes of chest pain and ensure proper diagnosis and appropriate management.

It is important not to overlook or dismiss the chest pain following a colonoscopy as it can indicate gastrointestinal reflux disease, musculoskeletal problems, esophageal perforation, or a pulmonary or cardiac cause. Seeking medical attention from a healthcare professional is crucial to determine the exact cause and appropriate treatment. A proper evaluation is necessary for the proper management of any underlying condition and to alleviate any potential concerns.

There can be different reasons a person experiences chest pain after a colonoscopy.

The manipulation of the gastrointestinal tract during a colonoscopy procedure can trigger or worsen gastroesophageal reflux disease. There can be acid reflux from the stomach into the esophagus, which may lead to chest pain and discomfort during colonoscopy.

The positioning and pressure applied during the colonoscopy can strain the muscles and joints in the chest and upper body. This strain can lead to musculoskeletal chest pain. The pain is mostly localized and worsens with movement.

Sometimes the passage of the colonoscope through the esophagus can irritate the esophageal lining or cause spasms. This may cause chest pain and discomfort.

Colonoscopes may sometimes cause perforation or tear in the esophagus causing severe chest pain associated with difficulty swallowing, fever, and other signs of infection.

The introduction of air or gas in the colon during the colonoscopy procedure may cause temporary bloating that might result in discomfort or referred pain in the chest.

Some people may experience anxiety and stress before and during a colonoscopy procedure. These emotional factors may contribute to chest pain or tightness.

Pneumothorax is a condition in which the air leaks into the space between the lung and chest wall. The air may push the lung and cause it to collapse. According to research done in 2017, there are only 22 cases of pneumothorax following colonoscopy.⁽²⁾ A person may experience sharp and stabbing chest pain.⁽⁴⁾

Most of the cases of chest pain post colonoscopy are not associated with serious complications. It is important to rule out any significant underlying issue and get appropriate treatment and reassurance.

Diagnosis and evaluation of chest pain involves a comprehensive medical assessment to determine the underlying cause.

The following steps are involved in the diagnostic process:

• Medical History: The patient’s medical history including pre-existing conditions, previous cardiac events, gastrointestinal issues, and medications are reviewed. The nature, duration, and intensity of the chest pain and the associated symptoms are also enquired about.
• Physical Examination: A physical examination focused on the chest, cardiovascular system, and gastrointestinal system is performed. The vital signs, heart sound, and lung sounds are assessed. The doctor also palpates the chest and the abdomen.
• Electrocardiogram: EGC is performed that measures the electrical activity of the heart. It can be helpful in identifying the heart rhythm and detecting the signs of a heart attack.
• Cardiac Enzyme Testing: Blood tests involving Troponin levels are performed to check for cardiac muscle damage and other indicators of a heart attack.
• Imaging Test: X-ray, echocardiogram, and stress test can be performed that may evaluate the heart and the surrounding structures.
• Gastrointestinal Evaluation: If gastrointestinal causes are suspected additional tests to assess the esophagus, stomach, or colon may be performed, which involves upper endoscopy, esophageal manometry, or further imaging test.

Depending on the finding, a referral to a specialist is placed for further evaluation and management.

The treatment and management of chest pain post-colonoscopy depend on the underlying cause.

The various options are as follows:

• Gastroesophageal Reflux: In the case of gastroesophageal reflux disease due to colonoscopy, the person is recommended lifestyle modifications and medication to manage the chest pain. This may include dietary changes, avoiding triggers, weight management, elevating the head of the bed, and using antacids, proton pump inhibitors, or H2 blockers.
• Musculoskeletal Strain: Over-the-counter pain relievers and hot and cold packs can be helpful in alleviating musculoskeletal chest pain. Physical therapy or gentle stretching exercises can also prove to be beneficial for relieving muscle tension.
• Esophageal Irritation and Spasm: Medications such as calcium channel blockers or nitrates are given to relax esophagus muscle and spasms caused by chest pain.
• Treatment of Underlying Gastrointestinal Condition: In case of esophagitis or peptic ulcers treatment targeting them including proton pump inhibitors, antibiotics, and medications to reduce inflammation are prescribed.
• Referral to Cardiology: If cardiac causes are identified, the patient is referred to a cardiologist for further evaluation and management.

Depending on the specific condition, regular follow-up appointments may be scheduled to monitor progress and perform further needed investigations.

It is important to adhere to the treatment plan prescribed by the healthcare professional and to seek prompt medical attention if the pain worsens or is severe. It may be indicating a more severe condition that may be requiring immediate intervention.

Chest pain after colonoscopy is not a common occurrence but may need to be taken seriously and medical attention may be needed. The cause may vary, ranging from gastrointestinal issues, gastroesophageal reflux disease, musculoskeletal strain, and in rare cases cardiac-related problems. A comprehensive medical assessment including a review of medical history, physical examination, electrocardiogram, enzyme testing, and imaging studies may be needed. Gastrointestinal evaluation may also be conducted if needed.

The treatment and management would depend on the underlying cause identified. It may involve lifestyle modifications, medications, physical therapy, or referral to a specialist such as a gastroenterologist or a cardiologist. Regular follow-up appointments may be necessary to assess the progress and make any adjustments to the treatment plan.

It is always important to consult a healthcare professional for personalized advice and guidance regarding chest pain or any other health concern.