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Provocation testing in noncardiac chest pain.

T T Nostrant1

  • 1Department of Internal Medicine, University of Michigan Hospital, Ann Arbor 48109-0362.

The American Journal of Medicine
|May 27, 1992
PubMed
Summary
This summary is machine-generated.

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Provocation testing for noncardiac chest pain is debated due to variable accuracy. While some advocate abandoning it, others suggest judicious use alongside 24-hour pH and pressure monitoring for better diagnosis.

Area of Science:

  • Gastroenterology
  • Cardiology
  • Diagnostic Medicine

Background:

  • Provocation testing is standard for noncardiac chest pain, aiming to identify esophageal sources.
  • Recent studies challenge its validity, creating debate among experts regarding its sensitivity and specificity.

Purpose of the Study:

  • To evaluate the role and mechanisms of esophageal provocation testing in diagnosing noncardiac chest pain.
  • To discuss the interplay between esophageal stimuli, acid reflux, dysmotility, and potential cardiac involvement.

Main Methods:

  • Review of studies on acid infusion, cholinergic stimulation, and balloon distention tests.
  • Integration of findings with 24-hour esophageal pH and pressure monitoring data.
  • Examination of stress, defined stressors, and altered pain perception in chest pain pathways.

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Main Results:

  • Provocation tests show varied diagnostic yield; some experts advocate for judicious use.
  • 24-hour monitoring reveals chest pain linked to acid reflux and esophageal dysmotility.
  • Provocation agents may affect coronary flow reserve, raising concerns about cardiac origins.

Conclusions:

  • Esophageal distention and acid play significant roles in inducing chest pain.
  • Mechanisms of esophageal chest pain remain incompletely understood.
  • Stress and altered pain perception may represent common pathways for chest pain.