[Pseudo-angina pain of esophageal origin. Results of functional study and value of the balloon distention test]

Abstract

In patients with angina-like chest pain, the diagnostic value of esophageal investigations has not been definitively established. The aim of this study was to assess the diagnostic value of different esophageal investigations in 45 patients (group I) with angina-like chest pain for which a cardiac origin had been previously excluded. These investigations included esophageal manometry, Bernstein test, edrophonium test, balloon distention test, and 24-hour pH monitoring (with event marker). These patients were compared to two control groups: a) 9 subjects with documented coronary disease (group IIa), and b) 9 healthy volunteers (group IIb). Abnormal results were observed in 37 patients in group I (82 percent), and in 4 patients in group IIa (44 percent). In group I, manometry was abnormal in 29 percent of patients and pH monitoring in 41 percent; provocative tests were positive in 10 percent, 15 percent, and 38 percent for the Bernstein test, edrophonium test, and balloon distention test respectively. Esophageal origin of the pain was shown to be likely in 36 percent of patients in group I. These results confirm the high incidence of functional abnormalities of esophagus in patients with angina-like chest pain. They also confirm the diagnostic value of the different provocative tests and especially the balloon distention test.