Rj. Adamek et al., ESOPHAGEAL MOTILITY DISORDERS AND THEIR COEXISTENCE WITH PATHOLOGICALACID REFLUX IN PATIENTS WITH NONCARDIAC CHEST PAIN, Scandinavian journal of gastroenterology, 30(9), 1995, pp. 833-838
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.