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

Abstract

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.

A prospective study of oesophageal function in patients with normal coronary angiograms and controls with angina

“…The sample of controls with confirmed angina is small, though it represents one of the largest series reported to date. It is our experience, and that of others, that such patients often decline oesophageal testing 5. No differences in age, sex, smoking habits, chest pain characteristics, or oesophageal symptoms were noted between our sample and a larger group of patients with confirmed coronary artery disease.…”

Upper Gastrointestinal Issues in Athletes

“…However, reliance on classical symptoms excludes many patients with GERD who experience atypical symptoms including hoarseness, cough, sore throat, bronchitis, asthma, recurrent pneumonia, intermittent choking, or chest pain. Both DeMeester et al (13) and Schofield et al (48) report on patients with exertional chest pain initially thought to be secondary to angina, who were found, in fact, to have normal coronary arteries but documented esophageal reflux upon further testing.…”

Should Noncardiac Chest Pain Be Treated Empirically?

“…This is supported by case series that report a high incidence of esophageal abnormalities, most frequently GERD, on investigation, and small randomized trials of patients with NCCP and GERD whose condition improved with reflux treatment. 4,5,20,[59][60][61] Although it is increasingly believed that GERD is the most common cause of NCCP, other possible nongastrointestinal causes cited in the literature include microvascular angina, psychiatric disorders such as panic attacks, and mitral valve prolapse. [62][63][64][65] It is likely that these are much less common causes of NCCP than GERD.…”

“…3 Subsequent investigations of these patients suggest that up to 60% have an esophageal source for the pain, with gastroesophageal reflux disease (GERD) being the most commonly associated abnormality. [3][4][5] There are currently no published clinical trials addressing the issue of empirical treatment vs workup and subsequent treatment of patients with NCCP. There are consensus guidelines from the American Gastroenterology Association for the diagnosis of NCCP, but these only review the available investigations and do not recommend a particular sequence or discuss empirical treatment.…”