Abnormal esophagocardiac reflex in patients with non-cardiac chest pain

As the mechanoreceptor stimulation of the esophagus activates an esophagoca rdiac inhibitory reflex, with possible cardiac hypokinetic arrhythmias, we investigated whether patients with non-cardiac chest pain have this reflex, which could represent a source of risk in predisposed individuals during t he intraesophageal balloon distension test. Electrocardiogram readings were recorded in nine patients with non-cardiac chest pain (group A), the esoph ageal origin of which was diagnosed with cardiac and esophageal examination s, in 10 patients with hyperkinetic esophageal motor disorders without ches t pain (group B), and in eight normal subjects used as controls (group C), after swallowing solid boluses and during intraesophageal balloon inflation at 100 mmHg for 10 s. The percent variation of the R-R interval from its m ean basal value to its highest value observed after stimulation was calcula ted. Solid swallows induced an increase in heart rate followed by a decreas e that was significantly higher in group B than group C, while group A was not significantly different from group C. Balloon inflation induced a signi ficant decrease in heart rate in all groups, but in group A the degree of d ecrease was significantly lower than in groups B and C. In conclusion, esop hageal wall distension, either as a result of solid bolus or balloon inflat ion, elicits an inhibitory esophagocardiac reflex that is higher than norma l in patients with hyperkinetic esophageal motor disorders without pain and lower than normal in patients with non-cardiac chest pain of esophageal or igin, who, consequently, have nothing to fear from this procedure.