Non-Cardiac Chest Pain (NCCP) refers to retrosternal chest pain not related to ischemic heart disease, which can occur for many reasons, among which Gastroesophageal Reflux Disease (GERD) is the most common cause. Acidic gastric reflux material irritates the esophageal mucosa, often causing symptoms such as heartburn, and in some patients, angina-like retrosternal pressure pain radiating to the back of the shoulders, which is easily misdiagnosed as other diseases and deserves clinical attention. When GERD is characterized by complications, it is easy to be misdiagnosed as other diseases, which deserves clinical attention. Meanwhile, NCCP is often associated with different degrees of psychiatric disorders, which are reported as follows. 1.1 General information: 33 patients, 10 men and 23 women, aged 31-65 years old, average age 50.4 years old, with a history of hypertension in 5 cases and diabetes mellitus in 7 cases, all of whom suffered from retrosternal or precordial pain as the main symptom, with a duration ranging from a few minutes to one hour, and with a history of more than 6 months. 1.2 Diagnostic and treatment process: Through the inquiry of medical history, it was found that the chest pain episodes had no obvious relationship with physical activities, and were more frequent when lying down after meals or in the morning, and the cardiovascular specialist examination ruled out the cardiogenic chest pain, and the possibility of NCCP was considered. All cases in this group had a long duration of illness and did not include cases of acute chest pain such as traumatic chest pain, spontaneous pneumothorax, aortic coarctation, pulmonary embolism, and herpes zoster. Electron gastroscopy, PH measurement, electrocardiogram test, proton pump inhibitor (PPI) treatment and assessment of mental status were used, and the findings were analyzed against the patients’ subjective symptom records. Twenty-five patients (75.8%) presented with GERD at the same time as subjective symptoms; eight patients (24.2%) presented with subjective symptoms without GERD, and the endoscopy and PH tests were negative, and the diagnosis of functional chest pain (FCP) was made; and five patients (15.2%) presented with subjective symptoms with GERD and electrocardiogram (ECG) ST-type chest pain. GERD and electrocardiogram ST-T changes (previous episodes, Holter examination have ST-segment downshift and T-wave inversion or flattening, and diagnosed as coronary artery disease, angina pectoris, long-term oral nitroglycerin, quick-acting rescue pills and other anti-angina drugs, the effect is not significant, and from time to time episodes). ;15 patients (45.5%, 7 of them FCP) were accompanied by different degrees of anxiety, depression and other symptoms. In 5 patients with ST-T downshift on ECG, antianginal drugs were also discontinued after ECG exercise stress test and 64-row CT coronary imaging or coronary angiography to exclude myocardial ischemic factors. All patients were treated with domperidone 10 mg 3 times/day, pantoprazole enteric-coated tablets 40 mg 1 time/day, and compound glutamine granules 0.67 g 3 times/day; patients with psychiatric symptoms were asked to add olanzapine tablets 2.5-5 mg 1 time/night after neurology consultation; the course of treatment lasted 4 weeks.After 1 course of treatment, chest pain symptoms were reduced or disappeared in all 31 cases (93.9%), and there were 2 cases of FCP After 1 course of treatment, 31 cases (93.9%) had their chest pain symptoms reduced or disappeared, while 2 cases of FCP had no obvious relief of symptoms; 5 patients with ST-T changes on ECG had their ST-T segments shifted downward and T-wave inversion or flattening disappeared on repeat examination. Chest pain is the most common problem encountered in outpatient and emergency departments, and the diagnosis of chest pain depends on the history, pain location, nature, severity, duration, triggering factors, past history, family history, as well as systematic physical examination and necessary auxiliary examinations. There are many causes of chest pain, cardiogenic and pulmonary chest pain are relatively common, while esophageal-induced gastrointestinal chest pain is not uncommon, and statistics show that gastrointestinal chest pain is the most common, accounting for 50% of non-cardiogenic angina-like chest pain; and some studies have proved that once heart disease is ruled out, GERD is the most likely cause of the disease. The pathogenesis of GERD is mainly due to lower esophageal sphincter (LES) dysfunction, especially transient lower esophageal sphincter relaxation (TLESR), along with a lack of esophageal peristalsis and delayed gastric emptying, which decreases esophageal contouring ability. The mainstay of medical treatment is the administration of proton pump inhibitors (PPIs) and gastrointestinal motility-enhancing drugs, which inhibit gastric acid secretion and at the same time enhance gastroesophageal peristalsis in order to improve esophageal contouring and reduce acid reflux in the stomach. Since the heart and digestive organs are both innervated by vegetative nerves, and pain is mainly transmitted by sympathetic nerves, the nociceptive fibers of the two and the nociceptive fibers of the thoracic tissues sometimes overlap and cross over each other in the central nervous system, and may converge in the same neuron of the same spinal cord segment and share a common conduction pathway. Since superficial pain is more common than visceral pain, the central nervous system often misinterprets visceral pain as coming from the superficial tissues of the body and manifests it as chest pain. In this paper, 25 cases of GERD achieved satisfactory results after the above treatment. Esophageal chest pain manifested as angina-like chest pain should be differentiated from coronary angina. In this group of cases, there are 5 cases of angina-like chest pain, and ST-segment shift and T-wave inversion or flattening, esophageal chest pain is mostly related to diet and position change, less related to physical labor and emotional excitement, etc., and often accompanied by a series of digestive symptoms, the treatment of nitroglycerin, in addition to esophageal spasm, pancreatic dystrophy, most of them are ineffective, and the treatment of gastrointestinal tract diseases, such as proton pump inhibitors, etc., often have a significant effect. Some authors believe that increased acidity in the esophagus is closely related to chest pain and electrocardiogram (ECG) ST-T changes, and that while acidic reflux stimulates the esophageal mucosa and causes angina-like chest pain, it can cause secondary cardiac neurovascular changes and lead to electrocardiogram (ECG) ST-T changes. In our group, five patients with ECG ST-T changes disappeared after the above treatment, and the performance of Holter ST-segment downshift and T-wave inversion or flattening disappeared after review. In this group of cases, we found that a significant proportion (45.5%) of NCCP patients with combined psychiatric symptoms had obvious character defects such as introversion, timidity, suspiciousness or insomnia and dreaminess. The proportion of FCP patients with comorbid psychiatric symptoms was even higher (87.5%).A study by Ortiz-Olvera et al. also showed that the overall proportion of NCCP patients with comorbid psychiatric disorders was 52%, with 48% for GERD and 60% for FCP, which led the authors to conclude that NCCP often needs to be managed through a multidisciplinary approach. In our group, 13 of the 15 patients with psychiatric symptoms were treated with additional anxiolytic therapy, and the symptoms of chest pain were significantly relieved or disappeared, which also confirmed that psychoneurologic factors have a role in the development of NCCP. In summary, NCCP is most common in GERD, which can be treated with PPI-based comprehensive treatment; GERD patients may have electrocardiographic changes while subjective symptoms are caused by decreased acidity in the esophagus, and the chest pain will improve and electrocardiographic changes will disappear after PPI treatment; NCCP is often combined with different degrees of psychiatric symptoms, and for such patients, attention should be paid to the assessment of their psychiatric and psychological conditions, reasonable guidance, and if necessary, the use of psychotropic drugs. For these patients, attention should be paid to evaluating their psychosocial status, rational counseling, and the use of psychotropic drugs if necessary, in order to help alleviate the symptoms to a greater extent.