Analysis of 24-hour esophageal pressure and pH data in unselected patients with noncardiac chest pain

Breumelhof, R.; Nadorp, J. H. S. M.; Akkermans, L.M.A.; Smout, AndréJ.P.M.

doi:10.1016/0016-5085(90)91147-x

Cited by 116 publications

(47 citation statements)

References 14 publications

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“…Although there are no "gold standards", many researchers recognize the Bernstein test, 24-h pH probe and manometry to be very helpful in diagnosing gastro-oesophageal reflux disease and oesophageal dysmotility. Unfortunately, these tests are invasive, technical and time consuming and may yield results which are difficult to interpret (Breumelhof et al 1990). Consequently, a simple, non-invasive screening test for oesophageal causes of NCCP is needed.…”

Section: Introductionmentioning

confidence: 99%

The clinical utility of provocative radionuclide oesophageal transit in the evaluation of non-cardiac chest pain

et al. 1992

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We combined edrophonium provocative testing with the technique of radionuclide oesophageal transit (RET) in 30 consecutive patients with non-cardiac chest pain (NCCP) and 12 controls. The oesophageal transit time of aqueous technetium-99m sulfur colloid was determined before and after intravenous infusion of 80 micrograms/kg edrophonium chloride (ED). Patient symptoms during provocative RET (P-RET) were recorded. Thirteen (43%) of the patients had abnormal study results, whereas all control subjects had normal results. Three groups considered abnormal were observed: (a) in two patients (6%), the pain was reproduced and transit pre- and post-ED administration was prolonged (greater than 15 s); (b) in six patients (20%), the pain was reproduced, but transit was normal pre- and post-ED; (c) in five patients (17%), transit pre- and post-ED was prolonged, but no pain was reproduced. In five patients (17%), ED prolonged the transit time greater than 15 s without pain, but the baseline transit was normal. Transit time was measurable in 23 patients. Mean pre-ED transit time was 10.2 +/- 7.4 s (mean +/- SD) and post-ED, 12.4 +/- 8.0 s (P = 0.3). We conclude that ED has no significant effect on transit time, and the pain induced by ED rarely correlates with an abnormal transit; P-RET provides additional information to baseline RET, increasing sensitivity, and may be a useful screening method in the evaluation of patients with NCCP.

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Section: Introductionmentioning

confidence: 99%

The clinical utility of provocative radionuclide oesophageal transit in the evaluation of non-cardiac chest pain

et al. 1992

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“…DiMarino et al [50] documented a symptomatic and manometric response to They found that 33% of the pain episodes were related to reflux, 23% to abnormal motility and 43% were normal both short-acting and long-acting nitrates. In another study by Kiendall and Mellow [51] it was suggested that [24]. Ghillebert et al [46] performed 24-hour intraesophageal pH, manometric recordings and provocative tests the effect of nitroglycerine might be short lived.…”

Section: Therapy Directed Towards Motor Dysfunctionmentioning

confidence: 99%

“…and may change over time, even reverting to normal [22,23]. There is also a significant lack of association 'Irritable Esophagus' and Visceral Hyperalgesia Many investigators have increasingly come to believe between contraction abnormalities and chest pain as determined by ambulatory manometry [21,23,24] as well that symptoms in patients with NCCP may in fact result from an associated disorder of sensory perception that as by the response to either pharmacological reduction or amplification of contraction amplitudes [25,26]. Fi-can be assessed by the response to balloon distention [31].…”

Section: Spastic Motility Disorders Of Esophagusmentioning

confidence: 99%

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Update on Noncardiac Chest Pain

Shrestha

Pasricha

2000

Dig Dis

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Patients with recurrent angina-like chest pain with normal coronary vessels are deemed to have the syndrome of noncardiac chest pain (NCCP). These patients, despite having significant cardiac disease ruled out, often spend a restricted lifestyle believing they have cardiac disease. These recurrent episodes of chest pain may be related to gastroesophageal reflux disease (GERD), spastic motility disorders of the esophagus and esophageal (visceral) hyperalgesia. These disease entities are often difficult to diagnose and treat except for GERD and achalasia. Recent prospective double-blind studies have shown that about 44% of these patients may have underlying GERD. There is now more evidence to support the practice of empiric use of proton pump inhibitors (PPIs) as the first step in therapy. Newer modalities for diagnosis like endoscopic ultrasonography (EUS) showed that this group of patients had sustained muscular contractions of longer that 68 s during chest pain. These sustained contractions noted on EUS were secondary to isometric contraction of the circular muscle which did not cause luminal constriction nor was related to contraction of the longitudinal muscles which cannot be recorded by pressure manometry. Treatment is difficult if patients do not respond to high-dose PPIs. Other medications which are known to alter visceral hyperalgesia in low doses, such as tricyclic antidepressants like imipramine and desyrel, can be tried. Psychological intervention may be useful in the management of some of these patients.

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“…This stems from observations that 25% of patients with noncardiac chest pain exhibit manometric abnormalities such as dif fuse esophageal spasm [1][2][3] or high ampli tude, prolonged duration, peristaltic contrac tions [4], However, there is a poor correlation between pain and the occurrence of motor abnormalities [5][6][7], Similarly, in the early 1980s, it was claimed that phasic activity of the colon at 3 cycles/min was a pathogno monic feature of patients with IBS [8,9], However, recent studies have shown that this type of phasic activity is a normal feature of the healthy rectum [10,11] and that it occurs more often at night than during the daytime [12]. Nonetheless, the motility Mafia presses on resolutely.…”

mentioning

confidence: 99%

Visceral Hyperalgesia: The Key for Unraveling Functional Gastrointestinal Disorders

Rao

1996

Dig Dis

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Analysis of 24-hour esophageal pressure and pH data in unselected patients with noncardiac chest pain

Cited by 116 publications

References 14 publications

The clinical utility of provocative radionuclide oesophageal transit in the evaluation of non-cardiac chest pain

The clinical utility of provocative radionuclide oesophageal transit in the evaluation of non-cardiac chest pain

Update on Noncardiac Chest Pain

Visceral Hyperalgesia: The Key for Unraveling Functional Gastrointestinal Disorders

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