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Esophageal motility patterns in patients with and without coronary heart disease and healthy controls
R J Adamek1, B Roth, C H Zymanski
1Department of Medicine, St. Josef-Hospital, Ruhr-University of Bochum, Germany.
Insights
Chest pain patients, with or without coronary artery disease, exhibit distinct esophageal motility patterns compared to controls. These findings suggest "non-cardiac" chest pain is not a sufficiently accurate descriptor.
Area of Science:
- Gastroenterology
- Cardiology
- Diagnostic Medicine
Background:
- Chest pain is a common symptom with diverse etiologies.
- Distinguishing cardiac from non-cardiac causes can be challenging.
- Esophageal dysfunction is a potential contributor to chest pain.
Purpose of the Study:
- To evaluate and compare esophageal motility in patients presenting with chest pain.
- To investigate differences in esophageal function between patients with and without coronary artery disease (CAD).
- To determine if "non-cardiac" chest pain is an adequate diagnostic term.
Main Methods:
- Prospective study design.
- Inclusion of three groups: chest pain with normal coronary angiograms (NCA), chest pain with diagnosed CAD, and healthy controls (CG).
- Utilized long-term esophageal manometry for motility assessment.
Main Results:
- Significant differences in esophageal pressure amplitudes and contraction patterns were observed between patient groups and controls.
- Patients with NCA and CAD showed considerable overlap in esophageal motility disturbances.
- Specific metrics like percentage of propulsive and simultaneous contractions differed significantly.
Conclusions:
- Esophageal motility patterns in chest pain patients (both NCA and CAD) are significantly different from controls.
- The overlap in motility disturbances challenges the clear distinction implied by "non-cardiac" chest pain.
- The term "non-cardiac" chest pain inadequately describes the esophageal dysfunction present in these patients.
Background/Aims:
The aim of the study was to evaluate esophageal motility patterns in patients with chest pain with and without coronary artery disease, in order to elucidate the question: Does "non-cardiac" chest pain really exist?
Methodology:
Patients with chest pain and normal coronary angiograms, patients with chest pain and coronarographically diagnosed coronary artery disease and controls were prospectively studied with long-term manometry.
Results:
The pressure amplitudes were 38.3 (NCA)/39.82(CAD) and 30 (CG) mmHg (p<0.02, p<0.02) distally and 30/28.1 and 25.5 mmHg (p<0.02) proximally. The percentage of propulsive contractions were 51.5%/45% and 53.5% (p<0.05) and of simultaneous contractions were 18.5%/23% and 10% (p<0.0005, p<0.0001).
Conclusions:
Esophageal motility patterns of patients with chest pain and normal coronary angiograms and coronary artery disease differ significantly from controls. Both patient groups show a considerable overlap in motility disturbances. These data indicate that the term "non-cardiac" chest pain in fact does not sufficiently characterize patients' status.