INTRAESOPHAGEAL BALLOON DISTENSION TEST IN CHAGAS-DISEASE PATIENTS WITH NONCARDIAC CHEST PAIN

Patients with Chagas' disease often have chest pain as a prominent sym ptom. The objective of this study was to compare the results of intrae sophageal balloon distension in chagasic and nonchagasic patients with chest pain not caused by coronary obstruction. We studied 40 patients with chest pain and angiographically normal coronary arteries, 25 wit h a positive serologic test for Chagas' disease (Chagas group, 16 wome n, mean age 53 +/- 10 years), and 15 with a negative serologic test (c ontrol group, 11 women, mean age 46 +/- 10 years). All patients had ra diologic and endoscopic examinations of esophagus, stomach, and duoden um, esophageal manometry with the acid infusion test in the distal eso phagus, and intraesophageal balloon distension. None of them had esoph ageal dilation or any signs of cardiovascular disease. A 25-mm-long la tex balloon located 10 cm above the lower esophageal sphincter was inf lated and deflated over a period of 10 sec at 1-ml increments of air u ntil the subjects reported chest pain or to a maximum volume of 20 mi. The test caused chest pain in 14 subjects in the control group (93%) and in 12 in the Chagas' disease group (48%, P < 0.05). The mean volum e of air that caused chest pain was 10 +/- 3 mi in the control group a nd 15 +/- 4 mi in the Chagas' disease group (mean +/- so, P < 0.05). T he maximum intraesophageal pressure during the examination was higher in Chagas' disease patients with chest pain during balloon distension (60 +/- 21 mm Hg) than in patients who did not have chest pain (37 +/- 18 mm Hg, P < 0.05) and did not differ from the control group (48 +/- 16 mm Hg, P > 0.05). With the other examinations there was no differe nce between groups or between patients with or without chest pain duri ng the balloon distension test. Although esophagitis was observed in 4 7% of patients in the control group and in 40% of the Chagas' disease group, the acid infusion test was positive in 27% of patients in the c ontrol group and in 4% of patients in the Chagas' disease group. We co nclude that, as compared to a group of patients with similar chest pai n, chagasic patients are less sensitive to esophageal distension. Thus , it is unlikely that their chest pain is related to esophageal mechan isms.