THE DIAGNOSTIC-VALUE OF ESOPHAGEAL RADIONUCLIDE TRANSIT IN PATIENTS ADMITTED FOR BUT WITHOUT ACUTE MYOCARDIAL-INFARCTION

The use of radionuclide transit (RT) as a screening test for chest pai n of oesophageal origin has been debated. The aim of this study was to determine the value of RT as a screening test for oesophageal disorde rs in comparison with oesophageal manometry in patients admitted with acute chest pain but without acute myocardial infarction (non-AMI pati ents), and to assess the frequency of oesophageal disease present in t hese patients. A total of 222 non-AMI patients entered the study. An e xtensive examination programme comprised noninvasive cardiac studies, pulmonary studies, a careful physical examination of the musculoskelet al system, and oesophago-gastric examinations including endoscopy, pH monitoring of the oesophagus and a Bernstein test. In 91% of the patie nts one or more diagnoses were obtained. Based on clinical and laborat ory data a 'consensus' diagnosis was made. With manometry as the refer ence RT had a poor sensitivity (35%) but an acceptable specificity (82 %). With the consensus diagnosis as the gold standard the sensitivitie s of both manometry and RT were poor (29%), whereas the specificity of RT, but not of manometry, was very high (97%). Gastrointestinal diagn oses were found in 57% of the patients. In conclusion, none of the app lied oesophageal examinations are valuable as single screening tests. Both RT and manometry have low sensitivities. RT may be used as a chea p, noninvasive and rapid supplementary examination. When positive, it strongly supports further invasive studies of the oesophagus in non-AM I patients with unexplained chest pain.