ESOPHAGEAL MOTILITY DISORDERS AND THEIR COEXISTENCE WITH PATHOLOGICALACID REFLUX IN PATIENTS WITH NONCARDIAC CHEST PAIN

Background: The aim of this study was to determine which motility data of patients with noncardiac chest pain (NCCP) differ from those of co ntrols on the basis of long-term manometry and to evaluate the coexist ence of motility disorders and pathologic acid reflux. Further, motili ty disorders were tested as to whether they were secondary to acid ref lux. Methods: Combined long-term pH/manometry was performed in 95 pati ents with NCCP, using one pH-electrode and two pressure transducers. T he motility data were compared with those of healthy controls (n = 40) . In addition, an intraindividual patient-oriented motility analysis w as performed. Evaluated were the amplitude, the duration in the distal and proximal esophagus, and the type of propagation, propulsive and s imultaneous, of esophageal contractions. Ten patients with pathologic acid reflux and hypermotility disorders received 20 mg omeprazole twic e daily and were investigated again 4 weeks after therapy began. Resul ts: The median distal pressure amplitude (39.4 versus 28.9 mmHg, p < 0 .0001) and the median percentage of simultaneous contractions (18.5% v ersus 10%; p < 0.0001) were significantly higher in patients with NCCP than in controls. In addition, patients whose symptoms correlated wit h abnormal motility (n = 18) had a significantly higher median duratio n of contractions (3.8 sec versus 3.2 sec; p < 0.03) than controls. Pa tients with pathologic acid reflux showed a higher median distal press ure amplitude (38.3 mmHg versus 28.9 mmHg; p < 0.0001) and median perc entage of simultaneous contractions (18% versus 10%; p < 0.0001) than controls. Furthermore, a high rate of coexistence with hypermotility d isorders was observed (64%). These disorders persisted after acid supp ression therapy. Conclusions: Patients with NCCP differ from controls in their esophageal motility. Simultaneous contractions of increased a mplitude and duration are pathologic. The intraindividual patient-orie nted motility analysis is an appropriate evaluation method. Hypermotil ity disorders occur often in patients with pathologic acid reflux, but apparently they are not dependent on it.