Changing focus on unexplained esophageal chest pain
Article Abstract:
Future research may find that malfunctions along the nerve pathways are responsible for chest pain of unknown origin. Recent studies have examined the correlation between unexplained chest pain and disorders of the esophagus with mixed results. Preliminary animal studies have identified three types of nerve receptors in the esophagus that may one day explain the difference in pain perception in humans. One human study found no difference in routine esophagus measurements between patients with unexplained chest pain and healthy volunteers. However, there was evidence suggesting that 16% of the patients had irritable esophagus while none of the volunteers did. Another study that used a balloon technique to evaluate patients with unexplained chest pain found an overall increase in esophagus width, stiffness, and reactivity in patients as compared to healthy volunteers. This technique, however, has limited routine usefulness in identifying target patients due to the considerable overlap in individual measurements.
Publication Name: Annals of Internal Medicine
Subject: Health
ISSN: 0003-4819
Year: 1996
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Unexplained chest pain: the hypersensitive, hyperreactive, and poorly compliant esophagus
Article Abstract:
Impedance planimetry may prove to be useful in identifying a patient with an abnormally functioning esophagus who has unexplained chest pain. Impedance planimetry measures the physical properties of the esophagus wall by inflating a balloon in this passage leading to the stomach. Doctors evaluated 24 patients with unexplained chest pain (the study group) and 12 healthy volunteers (the control group) with impedance planimetry. Balloon inflation to a pressure of 20-50 centimeters (cm) H2O duplicated the chest pain in 83% of the study group. None in the control group reported chest pain at balloon pressures of 50 cm H20. Measurements of esophageal wall stiffness were significantly greater in the study group than in the control group. The pressure required to stimulate contractions in the esophagus was lower and the length of the contractions was longer in the study group than the control group.
Publication Name: Annals of Internal Medicine
Subject: Health
ISSN: 0003-4819
Year: 1996
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Diagnostic value of esophageal studies in patients with angina-like chest pain and normal coronary angiograms
Article Abstract:
Routine esophageal testing in patients with unexplained chest pain may not be helpful in identifying the cause of the chest pain. Doctors monitored esophageal pH and wall pressure, contraction frequency, the electrical activity of the heart, and chest pain frequency over a 24-hour period in 63 patients with unexplained chest pain and 22 healthy volunteers. They took additional measurements after chemically inducing chest pain. There was no significant difference in the esophageal wall pressure, chest pain frequency, or chemical analyses between the patients and the healthy volunteers over the 24-hr period. Injections of edrophonium chloride and hydrogen chloride duplicated the patients' typical chest pain in 25% of the patients. Abnormal electrical heart activity occurred in only 2% of the patients before reported chest pain and in 8% during chest pain over the 24-hr study period.
Publication Name: Annals of Internal Medicine
Subject: Health
ISSN: 0003-4819
Year: 1996
User Contributions:
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