THORACIC PAIN OF ESOPHAGEAL ORIGIN - EVAL UATION OF 125 CONSECUTIVE PATIENTS WITH RESTING ANGINA AND NORMAL CORONARY-ARTERY ANGIOGRAPHY

BACKGROUND: The esophagus may be the origin of chest pain clinically i ndistinguishable from that of myocardial ischemia. Gastroesophageal re flux (GER) and esophageal motility disorders (EMDs) are the main cause s of esophageal chest pain, and esophageal motility tests are importan t for an appropriate diagnosis. We studied 125 unselected patients wit h angiographically normal coronary arteries presenting with atypical ( resting) angina which was shown not to be of cardiac origin. METHODS: Stationary esophageal manometry and 24-hour pH studies were performed in all patients, and 116 of them were submitted to edrophonium provoca tion test (Tensilon((R)), 10 mg as IV bolus). RESULTS: Spastic EMDs we re identified as an isolated abnormality in 23 patients (18%), whereas GER was documented in 70 patients (56%). Esophageal dysmotility at ba seline manometry (n = 40), a positive edrophonium test (n = 19), abnor mal acid reflux indices by 24-hour pH recording (n = 62), and associat ion of chest pain with acid reflux during pH testing (n = 24) variably overlapped in many patients. The esophagus was directly blamed as the source of atypical angina in 33 patients (26%) who had induction of t heir usual chest pain by cholinergic stimulation and/or association of spontaneous pain events with acid reflux. CONCLUSIONS: Esophageal dys function in common in patients with atypical angina considered not to be of cardiac origin and contributes to patients' symptoms. Because th ey may detect treatable causes of chest pain such as GER or contribute to management by assessing the diagnosis of EMD, esophageal motility tests are indicated in many patients with noncardiac chest pain.