AMBULATORY ESOPHAGEAL MANOMETRY, PH-METRY, AND HOLTER ECG MONITORING IN PATIENTS WITH ATYPICAL CHEST PAIN

Standard Holter electrocardiographic (ECG) monitoring was combined wit h ambulatory esophageal manometry and pH-metry in 25 patients with aty pical chest pain in order to determine whether an association could be found between spontaneous pain episodes and ischemic ECG changes or e sophageal dysfunction. Results of ambulatory testing were compared to those obtained with standard esophageal manometry and provocative test ing. Twenty-two of the 25 patients experienced a total of 88 pain epis odes during ambulatory testing. Although 15 of the 22 patients (68%) e xperiencing pain during testing had at least one pain episode that cor related temporally with gastroesophageal reflux, esophageal dysmotilit y or ischemic ECG changes, 65% of all pain episodes were unrelated to abnormal esophageal events or ECG changes. Seventeen percent of pain e pisodes were associated with gastroesophageal reflux, 15% with esophag eal dysmotility, and 2% with a combined acid reflux and esophageal dys motility event. Only one pain episode was associated with ischemic ECG changes. Twelve of the 15 patients with chest pain episodes associate d with reflux or esophageal dysmotility had other identical pain episo des in which there was no correlation. Reproduction of a patient's pai n during standard manometry with provocative testing did not predict a strong correlation between the patient's spontaneous pain episodes an d esophageal dysfunction during ambulatory recordings. In summary, pat ients with atypical chest pain have relatively few spontaneous pain ep isodes that correlate with gastroesophageal reflux, esophageal dysmoti lity, or ischemic ECG changes. It appears that different stimuli can t rigger identical episodes of chest pain, which suggests that many of t hese patients may have dysfunction of their visceral pain sensory mech anisms.