Esophageal tests in the evaluation of non-cardiac chest pain

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Abstract
Aim. We investigated the frequency of esophageal abnormalities and its pattern in patients with non-cardiac chest pain (NCCP). Patients. 123 NCCP patients: normal coronary arteriogram, n = 46; minimal coronary arterial changes, including post-angioplasty or surgery, n = 21; normal exercise electrocardiography, n = 56. For comparison, 13 patients awaiting coronary artery bypass grafting were also assessed. Investigations. Endoscopy and esophageal biopsy, standard esophageal manometry, 24-h ambulatory esophageal pHmetry, tests of pain provocation (intravenous edrophonium and standardized exercise test) and pain perception (acid perfusion and balloon distension). The pre-surgical patients had only manometry and pHmetry. Results. 83% of NCCP patients had abnormalities: excess reflux (62 %) and abnormal motility (29 %) were the commonest. About one quarter had symptoms related to reflux episodes (symptom index > 75%). Abnormal pain perception (10%) and pain on provocation (25%) invariably co-existed with abnormal reflux or dysmotility. All 4 patient subgroups had similar proportions of pH and manometric abnormalities. Conclusion. In NCCP, esophageal function is frequently abnormal. In some patients, excess reflux is the cause of symptoms but the significance of the other esophageal abnormalities remains to be determined.

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