AMBULATORY ESOPHAGEAL PRESSURE, PH AND ECG RECORDING IN PATIENTS WITHNORMAL AND PATHOLOGICAL CORONARY ANGIOGRAPHY AND INTERMITTENT CHEST PAIN

The present study was performed to compare pain-related oesophageal mo tility, gastro-oesophageal reflux and ST-segment deviations in patient s with intermittent chest pain and normal or pathological coronary ang iography. Thirty patients (11 males, 19 females; mean age 54.8 years) with normal and 15 patients (12 males, 3 females; mean age 66.7 years) with pathological coronary angiography were investigated by 24-h oeso phageal pressure. pH and ECG recording. Chest pain correlated with mot ility abnormalities or gastro-oesophageal reflux occurred in 33% (10/3 0) of patients with normal coronary arteries and in 26% of patients wi th pathological coronary angiography. Symptomatic and asymptomatic ST- segment changes were less frequently observed in patients with normal angiography (4/30) than in patients with pathological coronary angiogr aphy (7/14; P = 0.02). Oesophageal dysfunction coincided with ST-segme nt deviation in 6.7% (2/30) of patients with normal and 40% (6/15) of patients with pathological coronary angiography (P = 0.02). The conclu sions reached were: (1) pain-correlated abnormal motility or gastro-oe sophageal reflux occurred in patients with normal and pathological cor onary angiography at the same frequency; (2) ambulatory motility and p H recording alone does not appear to differentiate between cardiac and non-cardic chest pain: (3) simultaneous ECG recording reveals a signi ficant correlation of ST-segment deviation and gastro-oesophageal refl ux or abnormal motility in patients with coronary artery stenosis.