Edrophonium: A Useful Provocative Test for Esophageal Chest Pain

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Abstract
Esophageal motility disorders may be an important cause of noncardiac chest pain. To improve diagnostic yield, the use of edrophonium as a provocative test for inducing esophageal chest pain was studied in 50 symptomatic patients without coronary artery disease and in 25 age-matched controls. Edrophonium (80 .mu.g/kg of body wt, i.v. bolus) induced chest pain in 15 (30%) patients and in no controls. Edrophonium increased esophageal amplitude and repetitive contractions to a similar degree in all subjects, but the change in duration (101 .+-. 13%) was signiicantly greater (P < 0.02) in patients in whom chest pain was induced. Drug specificity was assessed in 9 patients during cardiac catheterization, but no significant change was seen in coronary artery diameter, blood pressure or heart rate. Further clinical testing using a placebo control confirmed a positivity rate of 28% in 125 unselected patients with chest pain referred to the laboratory; false-positive tests were infrequent (5.6%). No important side effects were seen. Edrophonium is useful for provoking esophageal chest pain.