Skip to main content
SpringerLink
Log in

Prospective study on prevalence of esophageal chest pain in patients referred on an elective basis to a cardiac unit for suspected myocardial ischemia

  • Original Articles
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

The prevalence of esophageal chest pain was studied prospectively in patients referred on an elective basis to a cardiac unit for suspected myocardial ischemia. A group of 248 consecutive patients without previously documented heart disease was admitted for elective diagnostic coronary angiography. The clinical history classified 185 patients as having anginal pain and the coronary angiogram was normal in 48 of them. In 37 of these 48 patients full esophageal testing was performed including 24-hr intraesophageal pH and pressure recordings with indication of chest pain episodes as well as a number of esophageal provocation tests, ie, acid perfusion, edrophonium stimulation, balloon distension, and ergonovine stimulation, all performed under continuous esophageal manometric and electrocardiographic monitoring. In 19 of these 37 patients, the familiar chest pain could be reproduced by esophageal provocative testing without ischemic ST-T segment alterations; six of these 19 patients had also a positive 24-hr pH and pressure recording. These data strongly suggest an esophageal origin of chest pain in half the patients with typical angina and a normal coronary angiogram.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Likoff W, Segel BL, Kasparian H: Paradox of normal selective coronary arteriograms in patients considered to have unmistakable coronary heart disease. N Engl J Med 276:1063–1066, 1967

    Google Scholar 

  2. Waxler EB, Kimbris D, Dreifus LS: The fate of women with normal coronary arteriograms and chest pain resembling angina pectoris. Am J Cardiol 28:25–32, 1971

    Google Scholar 

  3. Kemp HG, Vokonas PS, Cohn PF, Gorlin R: The anginal syndrome associated with normal coronary arteriograms: Report of a six year experience. Am J Med 54:735–742, 1973

    Google Scholar 

  4. Ockene IS, Shay MJ, Alpart JS, Weiner BH, Dalen JE: Unexplained chest pain in patients with normal coronary arteriograms. A follow-up study of functional status. N Engl J Med 303:1249–1252, 1980

    Google Scholar 

  5. Wilcox RG, Roland JM, Hampton JR: Prognosis of patients with “chest pain? cause.” Br Med J 282:431–433, 1981

    Google Scholar 

  6. Heupler FA, Proudfit WL, Razavi M, Shirey EK, Green-street R, Sheldon WC: Ergonovine maleate provocative test for coronary arterial spasm. Am J Cardiol 41:631, 1977

    Google Scholar 

  7. Glazia JJ, Faxon DP, Melidossian C, Ryan TJ: The changing force of coronary spasm: A decade of experience. Am Heart J 116:572–576, 1988

    Google Scholar 

  8. Cannon RO, Epstein JE: “Microvascular angina” as a cause of chest pain with angiographically normal coronary arteries. Am J Cardiol 61:1338–1343, 1988

    Google Scholar 

  9. Opherk D, Zebe H, Weihe H, Mall G, Durr C, Gravert B. Mehmel HC, Schwarz F, Kubler W: Reduced coronary dilatory capacity and ultrastructural changes of the myocardium in patients with angina pectoris but normal coronary arteriograms. Circulation 63:817–825, 1981

    Google Scholar 

  10. Legrand V, Hodgson JM, Bates ER, Aueron FM, Mancini GBJ, Smith JS, Gross MD, Vogel RA: Abnormal coronary flow reserve and abnormal radionuclide exercise test results in patients with normal coronary angiograms. J Am Coll Cardiol 71:218–226, 1985

    Google Scholar 

  11. Dart AM, Davies AH, Dalal J, Ruttley M, Henderson HH: Angina and normal coronary arteriograms: A follow-up study. Eur Heart J 1:97–100, 1980

    Google Scholar 

  12. Fergunson SL, Hodges K, Hersch T, Jimich H: Esophageal manometry in patients with chest pain and normal coronary arteriograms. Am J Gastroenterol 75:124–127, 1981

    Google Scholar 

  13. DeMeester TR, O'Sullivan GC, Bermudez G, Midell A, Cimochowski GE, O'Drobinak J: Esophageal function in patients with angina-type chest pain and normal coronary angiograms. Ann Surg 196:488–498, 1982

    Google Scholar 

  14. Dart AM, Davies HA, Lowndes RH, Ruttley M, Henderson AN: Oesophageal spasm and angina: Diagnostic value of ergometrine (ergonovine) provocation. Eur Heart J 1:91–95, 1980

    Google Scholar 

  15. Eastwood GL, Weiner BH, Dickerson WJ, White EM, Ockene IS, Haffajee CI, Alpert JS: Use of ergonovine to identify esophageal spasm in patients with chest pain. Ann Intern Med 94:768–771, 1981

    Google Scholar 

  16. London RL, Ouyang N, Snape WJ Jr, Goldberg S, Hirshfeld JW, Cohen S: Provocation of esophageal pain by ergonovine or edrophonium. Gastroenterology 81:10–14, 1981

    Google Scholar 

  17. Davies HA, Kaye MD, Rhodes I, Dart AM, Henderson AH: Diagnosis of oesophageal spasm by ergometrine provocation. Gut 23:89–97, 1983

    Google Scholar 

  18. Koch KL, Curry RC, Feldman RL, Pepine CJ, Long A, Mathias JR: Ergonovine-induced esophageal spasm in patients with chest pain resembling angina-pectoris. Dig Dis Sci 27:1073–1080, 1982

    Google Scholar 

  19. Richter JE, Castell DO: Gastroesophageal reflux. pathogenesis, diagnosis and therapy. Ann Intern Med 97:93–103, 1982

    Google Scholar 

  20. Benjamin SB, Richter JE, Cordova CM, Knuff TE, Castell DO: Prospective manometric evaluation with pharmacologic provocation of patients with suspected esophageal motility dysfunction. Gastroenterology 84:893–901, 1983

    Google Scholar 

  21. Lee CA, Reynolds JC, Ouyang A, Baker L, Cohen S: Esophageal chest pain: Diagnostic value of high-dose Tensilon provocative testing. Gastroenterology 86:1156, 1984

    Google Scholar 

  22. Barish CF, Castell DO, Richter JE: Graded esophageal balloon distention: A new provocation test for noncardiac chest pain. Dig Dis Sci 31:1292–1298, 1986

    Google Scholar 

  23. Ghillebert G, Janssens J, Vantrappen G, Nevens F, Piessens J: Ambulatory 24 hour intra-esophageal pH and pressure recordings versus provocation tests in the diagnosis of chest pain of oesophageal origin. Gut 31:738–744, 1990

    Google Scholar 

  24. Hewson EG, Sinclair JW, Dalton CB, Wu WC, Castell DO, Richter JE: Acid perfusion test: Does it have a role in the assessment of noncardiac chest pain. Gut 30:305–310, 1989

    Google Scholar 

  25. Nasrallah SM, Hendrix EA: Comparison of hypertonic glucose to other provocative tests in patients with noncardiac chest pain. Am J Gastroenterol 82:406–409, 1987

    Google Scholar 

  26. De Caestecker JS, Pryde A, Heading RC: Comparison of intravenous edrophonium and oesophageal acid perfusion during oesophageal manometry in patients with noncardiac chest pain. Gut 29:1029–1034, 1988

    Google Scholar 

  27. Janssens J, Vantrappen G, Ghillebert G: 24-Hour recording of esophageal pressure and pH in patients with non-cardiac chest pain. Gastroenterology 90:1978–1984, 1986

    Google Scholar 

  28. Peters L, Maas L, Petty D, Dalton C, Penner D, Wu W, Castell D, Richter J: Spontaneous noncardiac chest pain. Evaluation by 24-hour ambulatory esophageal motility and pH monitoring. Gastroenterology 94:878–886, 1988

    Google Scholar 

  29. Breumelhof R, Smout AJPM, Breedyk LMA, Akkermans JHSM: Esophageal motility and gastroesophageal reflux in non-cardiac chest pain. A quantitative analysis of 24-hour data. Gastroenterology 96:A59, 1989

    Google Scholar 

  30. Soffer EE, Scalabrini P, Wingate DL: Spontaneous noncardiac chest pain: Value of ambulatory esophageal pH and motility monitoring. Dig Dis Sci 34:1651–1655, 1989

    Google Scholar 

  31. Hewson EG, Dalton CB, Richter JE: Comparison of esophageal manometry, provocative testing, and ambulatory monitoring in patients with unexplained chest pain. Dig Dis Sci 35:302–309, 1990

    Google Scholar 

  32. Vantrappen G, Hellemans J: Motility disturbances of the esophagus: achalasia and diffuse spasm.In Disease of the Esophagus. G Vantrappen, J Hellemans (eds). Berlin, Springer-Verlag, 1974, pp 287–366

    Google Scholar 

  33. Benjamin SB, Gerhardt DC, Castell DO: High-amplitude peristaltic esophageal contractions associated with chest pain and/or dysphagia. Gastroenterology 77:478–483, 1979

    Google Scholar 

  34. Vantrappen G, Janssens J, Hellemans J, Coremans G: Achalasia, diffuse esophageal spasm and related motility disorders. Gastroenterology 76:450–457, 1979

    Google Scholar 

  35. Clouse RE, Staiano A: Contraction abnormalities of the esophageal body in patients referred for manometry: A new approach to manometric classification. Dig Dis Sci 28:784–791, 1983

    Google Scholar 

  36. Richter JE, Castell DO: Diffuse esophageal spasm: A reappraisal. Ann Intern Med 100:242–245, 1984

    Google Scholar 

  37. Freidin N, Traube M, Mittal R, McCallum R: The hypertensive lower esophageal sphincter. Manometric and clinical aspects. Dig Dis Sci 34:1063–1067, 1989

    Google Scholar 

  38. Richter JE, Wu WC, Johns DN, Blackwell JN, Nelson JL, Castell DA, Castell DO: Esophageal manometry in 95 healthy adult volunteers. Variability of pressures with age and frequency of “abnormal” contractions. Dig Dis Sci 32:583–592, 1987

    Google Scholar 

  39. Bernstein LM, Baker LA: A clinical test for esophagitis. Gastroenterology 34:760–781, 1958

    Google Scholar 

  40. Van Dorpe A, Piessens J, Willems JL, De Geest H: Unexplained chest pain with normal coronary arteriograms. A follow-up study. Cardiology 74:436–443, 1987

    Google Scholar 

  41. Vantrappen G, Janssens J, Ghillebert G: The irritable esophagus—a frequent cause of angina-like chest pain. Lancet 1:1232–1234, 1987

    Google Scholar 

  42. Vantrappen G, Janssens J: What is irritable esophagus? Another point of view. Gastroenterology 94:1092–1094, 1988

    Google Scholar 

  43. Mellow MH, Simpson AG, Watt L, Schoolmeesters L, Haye OL: Esophageal acid perfusion in coronary artery disease. Gastroenterology 85:306–312, 1983

    Google Scholar 

  44. Davies AH, Page Z, Rush EM, Brown AL, Lewis MJ, Petch MC: Oesophageal stimulation lowers exertional angina threshold. Lancet 1:1011–1014, 1985

    Google Scholar 

  45. Sox FI, Cannon SO, Henson L, Epstein SE: Impaired forearm vasodilator reserve in patients with microvascular angina. N Engl J Med 317:1366–1370, 1987

    Google Scholar 

  46. Cattau EL, Cannon III RO, Epstein SE, Spurling TJ, Benjamin SB: The value of provocative esophageal manometric testing in distinguishing esophageal pain from microvascular angina. Am J Gastroenterol 82:930, 1987 (abstract)

    Google Scholar 

  47. Cattau EL, Hirszel R, Benjamin SB, Cannon RO: Esophageal motility disorders in patients with abnormalities of coronary flow reserve and atypical chest pain. Gastroenterology 92:1339, 1987

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Division of Gastroenterology, University Hospital Gasthuisberg, Leuven, Belgium

    F. Nevens, J. Janssens, J. Piessens, G. Ghillebert, H. De Geest &  G. Vantrappen

  2. Division of Cardiology, University Hospital Gasthuisberg, Leuven, Belgium

    F. Nevens, J. Janssens, J. Piessens, G. Ghillebert & H. De Geest

Authors
  1. F. Nevens
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Janssens
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Piessens
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. G. Ghillebert
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. H. De Geest
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. G. Vantrappen
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nevens, F., Janssens, J., Piessens, J. et al. Prospective study on prevalence of esophageal chest pain in patients referred on an elective basis to a cardiac unit for suspected myocardial ischemia. Digest Dis Sci 36, 229–235 (1991). https://doi.org/10.1007/BF01300762

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01300762

Key Words

Search

Navigation