Jh. Voskuil et al., PREVALENCE OF ESOPHAGEAL DISORDERS IN PATIENTS WITH CHEST PAIN NEWLY REFERRED TO THE CARDIOLOGIST, Chest, 109(5), 1996, pp. 1210-1214
Study objective: The prevalence of esophageal disorders (dysmotility a
nd/or gastroesophageal reflux) in patients with chest pain newly refer
red to a cardiologic clinic is unknown. The aims of our study were to
investigate the prevalence of esophageal abnormalities in these patien
ts and to assess the value of medical history in predicting the origin
of the patient's chest pain. Design: We evaluated 28 consecutive pati
ents who were newly referred to the cardiologist because of angina-lik
e chest pain, Patients with evidence of severe myocardial ischemia wer
e excluded. Cardiologic evaluation included medical history, physical
examination, EGG, and exercise testing; further cardiologic workup was
carried out only when considered necessary. Gastroenterologic evaluat
ion consisted of medical history, esophageal manometry, endoscopy, and
24-h ambulatory monitoring of esophageal pH and pressure. Measurement
s and results: In five patients a diagnosis of ischemic coronary arter
y disease was made, In only two of these five patients, the cardiologi
c history strongly suggested a cardiac origin of the pain. Twelve pati
ents had a pathologic 24-h pH profile, four of whom also had reflux es
ophagitis. Ten patients had symptomatic reflux. In only three of these
ten patients, the history was judged to be indicative of an esophagea
l origin of the chest pain, No motility disorders were found. Conclusi
ons: Thirty-six percent of the patients with chest pain newly referred
to a cardiologic out-patient clinic have symptomatic gastroesophageal
reflux. Neither cardiologic nor gastroenterologic history data have a
high predictive value with respect to the origin of the chest pain.