Oesophageal chest pain: a point of view.

Blackwell, J. N.; Castell, Donald O.

doi:10.1136/gut.25.1.1

Cited by 34 publications

(9 citation statements)

References 31 publications

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“…The prevalence of abnormal oesophageal motility in patients with normal coronary angiograms was signif icantly higher than in those with coronary artery disease, suggesting that the angina pectoris of the former group may be caused by the oesophageal motility disorder. Blackwell and Castell [11] and Blackwell et al [ 12] have emphasised that there are no published data on the results of oesophageal motility studies in patients with coronary artery dis ease; to our knowledge, this is the first study to address this question.…”

Section: Discussionmentioning

confidence: 73%

“…This has led to the use of provocation procedures, including intravenous edro phonium [10], in an attempt to induce chest pain coincident with oesophageal dysmotility. Blackwell and Castell [11] and Blackwell et al [ 12] have emphasised that there are no published data on the results of oesophageal motility studies in patients known to have coronary artery disease, with which compar ison should be made. Furthermore, many previous studies of oesophageal function in patients with 'angina pectoris and normal coronary angiograms' have included patients with atypical chest pain [9,13] and patients who had not been demonstrated to have en tirely normal coronary angiograms [3,9].…”

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confidence: 99%

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Oesophageal Function in Patients with Angina Pectoris: A Comparison of Patients with Normal Coronary Angiograms and Patients with Coronary Artery Disease

Schofield

Whorwell²,

Brooks³

et al. 1989

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Oesophageal function was assessed in 52 patients with angina pectoris whose coronary angiograms were completely normal and in 21 patients with angina pectoris who had significant coronary artery disease. During a standard oesophageal manometric study, abnormalities were found in 23 (44%) patients with normal coronary angiograms but in only 2 (10%) patients with coronary artery disease (p < 0.01). Twenty-four (46%) patients with normal coronary angiograms were found to have gastro-oesophageal reflux disease during 24-hour oesophageal pH monitoring. Of the 52 patients with normal coronary angiograms, 19 (37%) had gastro-oesophageal reflux disease and abnormal oesophageal motility, 5 (10%) had gastro-oesophageal reflux disease alone, and 7 (13%) had oesophageal motility disorder alone. The use of provocation procedures, including intravenous edrophonium during oesophageal manometry and treadmill exercise testing during pH monitoring, enabled the oesophageal abnormality to be demonstrated simultaneously with chest pain in 25 of these 31 patients. Typical angina pectoris, coincident with abnormal oesophageal motility, was precipitated in a subgroup of patients who had been shown to have oesophageal manometric abnormalities and gastro-oesophageal reflux disease by the infusion of hydrochloric acid into the oesophagus; both the chest pain and manometric abnormality resolved following the oral administration of antacid.

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Section: Discussionmentioning

confidence: 73%

mentioning

confidence: 99%

Oesophageal Function in Patients with Angina Pectoris: A Comparison of Patients with Normal Coronary Angiograms and Patients with Coronary Artery Disease

Schofield

Whorwell²,

Brooks³

et al. 1989

Digestion

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“…In the established clinical routine the patients are often referred to manometry, an acid reflux test, and endoscopy (2).…”

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confidence: 99%

Food-Stimulated Gastro-Oesophageal Reflux Demonstrated by Barium Examination

Christiansen¹,

Thommesen²

1986

Acta Radiologica. Diagnosis

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A prospective investigation on gastro-oesophageal reflux in 97 consecutive patients has been carried out by means of a barium examination employing the conventional method and after food stimulation. Gastro-oesophageal reflux was observed in 38 patients with and 15 patients without oesophageal symptoms. Gastro-oesophageal reflux was induced by two mechanisms, an active component after food stimulation and a passive component after the conventional method including respiratory manoeuvres and leg raising. In 32 patients, only the active component could be demonstrated and in 6 patients only the passive component. In the remaining 15 patients both active and passive components occurred. The clinical significance of the active and passive components in gastro-oesophageal reflux needs further investigation.

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“…Since then, it has become evident that approximately 20% of patients admitted to cardiac care units because of chest pain show no abnormalities in a detailed cardiological work-up [3] and that in a certain percentage of these patients the esophagus may be responsible for chest pain [4,5].…”

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confidence: 99%

The Nutcracker Esophagus: A Late Diagnostic Yield Notwithstanding Chest Pain and Dysphagia

et al. 1998

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The nutcracker esophagus, a primary motor disorder, is frequently associated with noncardiac chest pain. However, there are no data on whether its diagnosis, as in other esophageal motility disorders, is delayed. Since the disorder is frequently heralded by alarming symptoms such as chest pain and dysphagia, diagnosis should be made as soon as possible. In this study we assessed the diagnostic delay, if any, in patients with the nutcracker esophagus. Moreover, we were interested in whether the abnormalities described in the distal esophagus could also involve the entire viscus. Fifty-four subjects (age range 23-78 yr) with the nutcracker esophagus were assessed for clinical and manometric variables as an overall group and after dividing them into subgroups according to their symptoms. The manometric variables were compared with those obtained in 61 controls (age range 21-67 yr). Overall, a diagnosis of nutcracker esophagus was made after an average period of 36 +/- 6 months, and surprisingly, this was not different in the various subgroups complaining of either chest pain, dysphagia, or both. Analysis of manometric variables showed that the mean amplitude of contractions was significantly higher in the patients' group at all esophageal body levels, even in the proximal portions. Again, there were no significant differences among the subgroups of nutcracker esophagus with respect to the symptoms. Notwithstanding the presence of alarming symptoms, such as chest pain and dysphagia, the nutcracker esophagus is diagnosed on average after 3 years from the onset of symptoms. Manometric assessment seems to confirm that this entity may indeed represent a primary esophageal motor disorder. The major dysfunction is due to an abnormal increase of contraction amplitude of the entire esophageal body.

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Oesophageal chest pain: a point of view.

Cited by 34 publications

References 31 publications

Oesophageal Function in Patients with Angina Pectoris: A Comparison of Patients with Normal Coronary Angiograms and Patients with Coronary Artery Disease

Oesophageal Function in Patients with Angina Pectoris: A Comparison of Patients with Normal Coronary Angiograms and Patients with Coronary Artery Disease

Food-Stimulated Gastro-Oesophageal Reflux Demonstrated by Barium Examination

The Nutcracker Esophagus: A Late Diagnostic Yield Notwithstanding Chest Pain and Dysphagia

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