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Up to 26% of patients with angina-like chest pain sufficiently severe to necessitate more invasive examinations have normal coronary arteries on arteriography.1 Since the late 1970s, the oesophagus has gained notoriety as a possible cause of the chest pain in these patients. Depending upon the criteria used to accept an oesophageal origin of the pain, up to 50% of patients with normal coronary arteries have oesophageal pain. Gastroenterologists now widely accept that the best and possibly the only way to determine whether the oesophagus is the likely cause of the chest pain is to show a temporal correlation between the pain attack and an abnormal oesophageal event, such as acid reflux or severe motor disturbances.
Since the development of 24 hour pH and pressure measurements by the Leuven group, prolonged recordings have become a standard investigation in patients with non-cardiac chest pain.2 These measurements, which attempt to correlate symptoms with abnormal oesophageal events, led to the finding that most of the spontaneous pain attacks were reflux related, although many of these patients have a normal acid exposure on quantitative analysis of 24 …
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