ESOPHAGEAL DYSFUNCTION IN SYNDROME-X

Syndrome X is defined as anginal chest pain accompanied by objective s igns of ischemia on exercise testing or myocardial scintigraphy, but w ith angiographically ''normal'' coronary arteries, The etiology of thi s enticing syndrome is still not known. Besides myocardial ischemia, e sophageal dysfunction and visceral hypersensitivity may play a role in the development of pain. The purpose of this study was to study esoph ageal function and visceral sensitivity in patients with syndrome X. T wenty consecutive patients with the diagnosis of syndrome X were inves tigated with esophageal manometry and a 24-hour pH recording. Visceral esophageal sensitivity was explored by balloon distention of the dist al esophagus, as well as by instillation of acid. Twelve patients (67% of the 18 evaluated) had some abnormality on 24-hour pH monitoring; 2 had abnormal global acid exposure time (pH <4) and 7 had symptoms coi ncidental with episodes of pH <4, Seven patients (35%) had esophageal dysmotility including 5 with the ''nut-cracker'' esophagus, Esophageal hypersensitivity to acid (n = 9) or distention (n = 13) was seen in 1 4 of the 20 patients. Eleven patients received acid suppressive therap y that resulted in amelioration of chest pain in 8 (73%). Thus, result s suggest that esophageal hypersensitivity rather than gross functiona l abnormality is an important factor for the development of chest pain in patients with syndrome X, and that acid in the context of a hypers ensitive esophagus is the main culprit. Acid suppression may ameliorat e pain in a substantial proportion of patients, (C) 1998 by Excerpta M edica, Inc.