The Incidence of Esophageal Disease in Patients with Non-Cardiac Chest Pain

Song, Chul Soo; Seong, Eun Yung; Kim, Gwang Ha; Huh, Jung; Song, Guen Am; Cho, Mong; Yang, Ung Suk

Abstract

BACKGROUND AND AIMS: Recurring chest pain is an important clinical problem, causing anxiety for patients and their physicians because of the fear of possible cardiac disease. In these patients without evidence of cardiac disease, we investigated the esophageal origin of chest pain using manotaetry, provocative tests and 24 hour ambulatory esophageal pH monitoring.
METHODS
Between August 1995 and September 1996, 199 patients (M:76, F;123) were included in this study. They had no evidence of cardiac disease with echocardiography, exercise stress test and coronary perfusion scan.
RESULTS
89 out of 199 patients (44.7%) had abnormal manometric findings which were 31 (34.8%) nonspecific esophageal rnotility disorder, 27 (30.3%) Nutcracker esophagus, 22 (24.7%) hypertensive lower esophageal sphincter, 2 (2.2%) diffuse esophageal spasm, 7 (7.9%) achalasia. 18 out of 89 patients (20.2%) had positive edrophonium test which were 3 (16.7%) nonspecific esophageal motility disorder, 4 (22.2%) hypertensive lower esophageal sphicter, 2 (11.1%) diffuse esophageal spasm, 4 (22.2%) achalasia. 11 patients (10%) had positive Bemstein test and 2 patients which showed both positive provocation results were nonspecific esophageal motility disorder. In patients with normal esophageal motility, negative Bernstein test and symptoms of gastroesophageal reflux disease (GERD), we examined 24 hour ambulatory esophageal pH monitoring and 9 (23%) had pathologic reflux. In these 9 patients, amplitude of distal esophageal peri-staltic contraction and lower esophageal sphincter pressure were significantly lower than controls (C0.05).
CONCLUSIONS
These results suggest that the esophagus is a sourse of chest pain and distal esophageal motility may be an important role in preventing GERD. 24 hour ambulatory esophageal pH monitoring with esophageal manometry and provocative tests can increase the diagnostic rate of the esophageal origin of chest pain.