[A comparative prospective study of an edrophonium test and an esophageal balloon distension test in 78 patients with non-coronary angina and 12 healthy controls]

Abstract

The aim of this study was to compare the most current tests used for the diagnosis of esophageal angina-like pain: manometry, balloon distension, edrophonium provocation.

Method: 78 patients with angina-like pain, who had normal coronary arteriograms, and 12 healthy controls were prospectively evaluated with esophageal manometry, esophageal balloon distension, according to Barish's method (2), edrophonium provocation and 3 h pH-monitoring. Provocation tests were considered positive if they reproduced the angina-like pain.

Results: basal manometry was abnormal in 23 patients (29%); nutcracker esophagus; 8, achalasia; 1, diffuse esophageal spasm: 1, hypertensive LES: 2, non specific motility disorders: 5, It was abnormal in 1 healthy control (1 nutcracker esophagus). Edrophonium provocation was positive in 19 patients (24%) and in none of the controls. Balloon distension was positive in 33 patients (42%) and none of the controls, but 3 controls experienced a back pain at 7, 9 and 9 cc. Balloon distension was more sensitive than edrophonium provocation (p less than 0.001). There was no correlation between the results of the basal manometry and those of balloon distension and no correlation between pH monitoring and balloon distension. 1) Balloon distension is the most sensitive test and should be used at first. 2) If balloon distension is negative edrophonium provocation can be useful because the pain mechanism is different. 3) Some controls can experience a back pain without irradiation, then balloon distension must be considered positive only if it strictly reproduces the spontaneous angina-like pain.