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The Prevalence of Abnormal Esophageal Test Results in Patients With Cardiovascular Disease and Unexplained Chest Pain

The Prevalence of Abnormal Esophageal Test Results in Patients With Cardiovascular Disease and... Abstract • The purpose of our study was to assess the prevalence of esophageal test abnormalities in patients with known cardiovascular disease and persistent chest pain. We performed a retrospective review of symptoms, manometry, and provocative test results performed on patients with undiagnosed chest pain. The 220 patients with angiographically determined cardiac disease and persistent chest pain were divided into three groups: coronary artery disease (125 patients), mitral valve prolapse (38 patients), and coronary bypass/angioplasty (57 patients). A comparison group consisted of 159 patients with noncardiac chest pain. All patients underwent esophageal manometry and placebo-controlled provocative testing (acid perfusion test and edrophonium chloride test). The prevalence of esophageal motility disorders in the noncardiac chest pain group (27%) was similar to that in the coronary artery disease (24%), mitral valve prolapse (37%), and coronary bypass/angioplasty (30%) groups. The frequency of nutcracker esophagus (11% to 16%) and diffuse esophageal spasm (2% to 7%) was remarkably constant. The prevalence of any positive provocative result in the noncardiac chest pain group (27%) was similar to that in the coronary artery disease (19%), mitral valve prolapse (32%), and coronary bypass/ angioplasty (20%) groups. Furthermore, completely negative results of esophageal investigation occurred in 55%, 62%, 42%, and 59% of the respective patient groups. (Arch Intern Med. 1990;150:965-969) References 1. Brunnen PL, Karmody AM, Needham CD. Severe peptic esophagitis . Gut . 1969;10:831-837.Crossref 2. Svensson 0, Stenport G, Tibbling L, Wranne B. Oesophageal function and coronary angiogram in patients with disabling chest pain . Acta Med Scand . 1978;204:173-178.Crossref 3. Schofield PM, Bennett DH, Whorwell PJ, et al. Exertional gastro-esophageal reflux: a mechanism for symptoms in patients with angina pectoris and normal coronary angiograms . Br Med J . 1987;294:1459-1461.Crossref 4. Patel PH, Hunter W, Garcia-Pulido J, Douglas JE, Thomas E. Morbidity secondary to esophageal disorders in symptomatic patients with coronary artery disease . Am J Gastroenterol . 1987;82:924A. 5. Spears PF, Koch KL. Esophageal disorders in patients with chest pain and mitral valve prolapse . Am J Gastroenterol . 1986;81:951-954. 6. Haikal M, Alpert MA, Whiting RB, et al. Sensitivity and specificity of M mode echocardiographic signs of mitral valve prolapse . Am J Cardiol . 1982;50:185-190.Crossref 7. Engle PJ, Hickman JR, Cowley MJ. Angiographic diagnosis of posterior mitral leaflet prolapse . JAm Coll Cardiol . 1984;3:1085-1091.Crossref 8. Bertrand ME, LaBlanche JM, Tilmant PY, et al. Frequency of provoked coronary arterial spasm in 1089 consecutive patients undergoing coronary arteriography . Circulation . 1982;65:1299-1306.Crossref 9. Masseri A, Chierchia S. Coronary artery spasm: demonstration, definition, diagnosis and consequences . Prog Cardiovasc Dis . 1982;25:169.Crossref 10. Katz PO, Dalton CB, Richter JE, Wu WC, Castell DO. Esophageal testing of patients with noncardiac chest pain or dysphagia: results of three years' experience with 1161 patients . Ann Intern Med . 1987;106:593-597.Crossref 11. Richter JE, Johns DN, Wu WC, Castell DO. Are esophageal motility abnormalities produced during the intraesophageal acid perfusion test? JAMA . 1985;253:1914-1917.Crossref 12. Richter JE, Hackshaw BT, Wu WC, Castell DO. Edrophonium: a useful provocative test for esophageal chest pain . Ann Intern Med . 1985;103:14-21.Crossref 13. Areskog M, Tibbling L, Wranne B. Non-infarction coronary care unit patients . Acta Med Scand . 1981;209:51-57.Crossref 14. Alban-Davies H, Page Z, Rush EM, Brown AL, Lewis MJ, Petch MC. Oesophageal stimulation lowers exertional angina threshold . Lancet . 1985;1:1011-1014.Crossref 15. Mellow MH, Simpson AG, Watt L, Schoolmeester L, Haye OL. Esophageal acid perfusion in coronary artery disease: induction of myocardial ischemia . Gastroenterology . 1983;85:106-112. 16. Koch KL, Long AL, Mathias JR. Persistent chest pain after coronary artery bypass graft (CABG) surgery: a cardiac or esophageal problem? Gastroenterology . 1980;78:1196A. 17. Cheng TO. Mitral valve prolapse . Dis Mon . (September) 1987:487-534. 18. Savage DD, Garrison RJ, Devereux RB, et al. Mitral valve prolapse in the general population, I: epidemiological features: the Framingham Study . Am Heart J . 1983;106:571-576.Crossref 19. Peters L, Mass L, Petty D, et al. Spontaneous noncardiac chest pain: evaluation by 24-hour ambulatory esophageal motility and pH monitoring . Gastroenterology . 1988;94:878-886. 20. Keshavarzian A, Iber FL, Ferguson Y. Esophageal manometry and radionuclide emptying in chronic alcoholics . Gastroenterology . 1987;92:751-757. 21. Anderson KO, Dalton CB, Bradley LA, Richter JE. Stress induces alterations of esophageal pressures in healthy volunteers and non-cardiac chest pain patients . Dig Dis Sci . 1989;34:83-89.Crossref 22. DeCaestecker JS, Pryde A, Heading RC. Do esophageal motor abnormalities occur in patients with proven coronary artery disease? Gut . 1988;29:1447A. 23. Ducrotte PH, Berland J, Denis PH, et al. Coronary sinus lactate estimation and esophageal motor anomalies in angina with normal coronary angiogram . Dig Dis Sci . 1984;29:305-310.Crossref 24. Ward BW, Wu WC, Richter JE, Hackshaw BT, Castell DO. Long-term followup of symptomatic status of patients with non-cardiac chest pain: is diagnosis of esophageal etiology helpful? Am J Gastroenterol . 1987;82:215-218. 25. Lee CA, Reynolds JC, Ouyang A, Cohen S. Esophageal chest pain: value of high-dose provocative testing with edrophonium chloride in patients with normal esophageal manometries . Dig Dis Sci . 1987;32:682-688.Crossref 26. Richter JE. Acid perfusion (Bernstein) test . In: Castell DO, Wu WC, Ott DJ, eds. Gastroesophageal Reflux Disease: Pathogenesis, Diagnosis and Therapy . Mount Kisco, NY: Futura Publishing Co Inc; 1985:139-148. 27. Hewson EG, Sinclair JW, Dalton CB, Wu WC, Castell DO, Richter JE. The acid perfusion test: does it have a role in the assessment of noncardiac chest pain? Gut . 1989;30:305-310.Crossref 28. Hewson EG, Sinclair JW, Hackshaw BT, Richter JE. The role of ambulatory Holter/pH monitoring in coronary artery disease patients with refractory chest pain . Gastroenterology . 1989;96:208A. 29. Nasrallah SM, Hendrix EA. Comparison of hypertonic glucose to other provocative tests in patients with noncardiac chest pain . Am J Gastroenterol . 1987;82:406-409. 30. DeCaestecker JS, Pryde A, Heading RC. Comparison of intravenous edrophonium and oesophageal manometry in patients with non-cardiac chest pain . Gut . 1988;29:1029-1034.Crossref 31. Cannon RO, Benow RO, Bacharach SL, et al. Left ventricular dysfunction in patients with angina pectoris, normal epicardial coronary arteries, and abnormal vasodilator reserve . Circulation . 1985;71:218-226.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

The Prevalence of Abnormal Esophageal Test Results in Patients With Cardiovascular Disease and Unexplained Chest Pain

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References (35)

Publisher
American Medical Association
Copyright
Copyright © 1990 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1990.00390170027007
Publisher site
See Article on Publisher Site

Abstract

Abstract • The purpose of our study was to assess the prevalence of esophageal test abnormalities in patients with known cardiovascular disease and persistent chest pain. We performed a retrospective review of symptoms, manometry, and provocative test results performed on patients with undiagnosed chest pain. The 220 patients with angiographically determined cardiac disease and persistent chest pain were divided into three groups: coronary artery disease (125 patients), mitral valve prolapse (38 patients), and coronary bypass/angioplasty (57 patients). A comparison group consisted of 159 patients with noncardiac chest pain. All patients underwent esophageal manometry and placebo-controlled provocative testing (acid perfusion test and edrophonium chloride test). The prevalence of esophageal motility disorders in the noncardiac chest pain group (27%) was similar to that in the coronary artery disease (24%), mitral valve prolapse (37%), and coronary bypass/angioplasty (30%) groups. The frequency of nutcracker esophagus (11% to 16%) and diffuse esophageal spasm (2% to 7%) was remarkably constant. The prevalence of any positive provocative result in the noncardiac chest pain group (27%) was similar to that in the coronary artery disease (19%), mitral valve prolapse (32%), and coronary bypass/ angioplasty (20%) groups. Furthermore, completely negative results of esophageal investigation occurred in 55%, 62%, 42%, and 59% of the respective patient groups. (Arch Intern Med. 1990;150:965-969) References 1. Brunnen PL, Karmody AM, Needham CD. Severe peptic esophagitis . Gut . 1969;10:831-837.Crossref 2. Svensson 0, Stenport G, Tibbling L, Wranne B. Oesophageal function and coronary angiogram in patients with disabling chest pain . Acta Med Scand . 1978;204:173-178.Crossref 3. Schofield PM, Bennett DH, Whorwell PJ, et al. Exertional gastro-esophageal reflux: a mechanism for symptoms in patients with angina pectoris and normal coronary angiograms . Br Med J . 1987;294:1459-1461.Crossref 4. Patel PH, Hunter W, Garcia-Pulido J, Douglas JE, Thomas E. Morbidity secondary to esophageal disorders in symptomatic patients with coronary artery disease . Am J Gastroenterol . 1987;82:924A. 5. Spears PF, Koch KL. Esophageal disorders in patients with chest pain and mitral valve prolapse . Am J Gastroenterol . 1986;81:951-954. 6. Haikal M, Alpert MA, Whiting RB, et al. Sensitivity and specificity of M mode echocardiographic signs of mitral valve prolapse . Am J Cardiol . 1982;50:185-190.Crossref 7. Engle PJ, Hickman JR, Cowley MJ. Angiographic diagnosis of posterior mitral leaflet prolapse . JAm Coll Cardiol . 1984;3:1085-1091.Crossref 8. Bertrand ME, LaBlanche JM, Tilmant PY, et al. Frequency of provoked coronary arterial spasm in 1089 consecutive patients undergoing coronary arteriography . Circulation . 1982;65:1299-1306.Crossref 9. Masseri A, Chierchia S. Coronary artery spasm: demonstration, definition, diagnosis and consequences . Prog Cardiovasc Dis . 1982;25:169.Crossref 10. Katz PO, Dalton CB, Richter JE, Wu WC, Castell DO. Esophageal testing of patients with noncardiac chest pain or dysphagia: results of three years' experience with 1161 patients . Ann Intern Med . 1987;106:593-597.Crossref 11. Richter JE, Johns DN, Wu WC, Castell DO. Are esophageal motility abnormalities produced during the intraesophageal acid perfusion test? JAMA . 1985;253:1914-1917.Crossref 12. Richter JE, Hackshaw BT, Wu WC, Castell DO. Edrophonium: a useful provocative test for esophageal chest pain . Ann Intern Med . 1985;103:14-21.Crossref 13. Areskog M, Tibbling L, Wranne B. Non-infarction coronary care unit patients . Acta Med Scand . 1981;209:51-57.Crossref 14. Alban-Davies H, Page Z, Rush EM, Brown AL, Lewis MJ, Petch MC. Oesophageal stimulation lowers exertional angina threshold . Lancet . 1985;1:1011-1014.Crossref 15. Mellow MH, Simpson AG, Watt L, Schoolmeester L, Haye OL. Esophageal acid perfusion in coronary artery disease: induction of myocardial ischemia . Gastroenterology . 1983;85:106-112. 16. Koch KL, Long AL, Mathias JR. Persistent chest pain after coronary artery bypass graft (CABG) surgery: a cardiac or esophageal problem? Gastroenterology . 1980;78:1196A. 17. Cheng TO. Mitral valve prolapse . Dis Mon . (September) 1987:487-534. 18. Savage DD, Garrison RJ, Devereux RB, et al. Mitral valve prolapse in the general population, I: epidemiological features: the Framingham Study . Am Heart J . 1983;106:571-576.Crossref 19. Peters L, Mass L, Petty D, et al. Spontaneous noncardiac chest pain: evaluation by 24-hour ambulatory esophageal motility and pH monitoring . Gastroenterology . 1988;94:878-886. 20. Keshavarzian A, Iber FL, Ferguson Y. Esophageal manometry and radionuclide emptying in chronic alcoholics . Gastroenterology . 1987;92:751-757. 21. Anderson KO, Dalton CB, Bradley LA, Richter JE. Stress induces alterations of esophageal pressures in healthy volunteers and non-cardiac chest pain patients . Dig Dis Sci . 1989;34:83-89.Crossref 22. DeCaestecker JS, Pryde A, Heading RC. Do esophageal motor abnormalities occur in patients with proven coronary artery disease? Gut . 1988;29:1447A. 23. Ducrotte PH, Berland J, Denis PH, et al. Coronary sinus lactate estimation and esophageal motor anomalies in angina with normal coronary angiogram . Dig Dis Sci . 1984;29:305-310.Crossref 24. Ward BW, Wu WC, Richter JE, Hackshaw BT, Castell DO. Long-term followup of symptomatic status of patients with non-cardiac chest pain: is diagnosis of esophageal etiology helpful? Am J Gastroenterol . 1987;82:215-218. 25. Lee CA, Reynolds JC, Ouyang A, Cohen S. Esophageal chest pain: value of high-dose provocative testing with edrophonium chloride in patients with normal esophageal manometries . Dig Dis Sci . 1987;32:682-688.Crossref 26. Richter JE. Acid perfusion (Bernstein) test . In: Castell DO, Wu WC, Ott DJ, eds. Gastroesophageal Reflux Disease: Pathogenesis, Diagnosis and Therapy . Mount Kisco, NY: Futura Publishing Co Inc; 1985:139-148. 27. Hewson EG, Sinclair JW, Dalton CB, Wu WC, Castell DO, Richter JE. The acid perfusion test: does it have a role in the assessment of noncardiac chest pain? Gut . 1989;30:305-310.Crossref 28. Hewson EG, Sinclair JW, Hackshaw BT, Richter JE. The role of ambulatory Holter/pH monitoring in coronary artery disease patients with refractory chest pain . Gastroenterology . 1989;96:208A. 29. Nasrallah SM, Hendrix EA. Comparison of hypertonic glucose to other provocative tests in patients with noncardiac chest pain . Am J Gastroenterol . 1987;82:406-409. 30. DeCaestecker JS, Pryde A, Heading RC. Comparison of intravenous edrophonium and oesophageal manometry in patients with non-cardiac chest pain . Gut . 1988;29:1029-1034.Crossref 31. Cannon RO, Benow RO, Bacharach SL, et al. Left ventricular dysfunction in patients with angina pectoris, normal epicardial coronary arteries, and abnormal vasodilator reserve . Circulation . 1985;71:218-226.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: May 1, 1990

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