What condition might a patient with retrosternal pain and no signs of reflux be experiencing?

In the context of retrosternal pain accompanied by the absence of reflux signs, the condition that aligns with these symptoms is a paraesophageal hiatus hernia. This type of hernia occurs when part of the stomach pushes through the diaphragm alongside the esophagus, which can lead to the displacement of the esophagus or the stomach, causing pain that can mimic cardiac issues.

Patients may experience discomfort in the retrosternal area due to pressure or irritation on nearby structures. The lack of signs consistent with refluxing content, such as heartburn or regurgitation, further supports the diagnosis of a paraesophageal hiatus hernia rather than gastroesophageal reflux disease, which typically presents with those reflux symptoms.

Additionally, peptic ulcer disease generally involves a more specific pattern of pain, often relating to food intake and may present with other gastrointestinal symptoms, while esophageal spasm is characterized by intermittent chest pain that can be related to swallowing. The specific symptoms and the absence of reflux make a paraesophageal hiatus hernia the most fitting condition in this scenario.