[Diagnostic evaluation of the patient with esophageal chest pain: our experience]

Our experience in the field of the "cardio-esophageal" differential diagnosis of angina-like pain derives from the close cooperation between the Divisions of Gastroenterology and Cardiology. Commonly applied tests of esophageal function, always performed during electrocardiographic monitoring, are prolonged gastro-esophageal pH monitoring plus the adoption, as provocative tests, of the stress test in the course pH monitoring, of endo-esophageal distension and of electrostimulation in the course of manometry. An evaluation of prolonged pH monitoring tracings is performed not solely to locate a quantitatively pathological reflux, but especially to identify temporal correlations between the symptoms and the reflux. This explains how we were able to relate pain to reflux in 63% of the patients who took the test. Furthermore, use of esophagogastric monitoring makes it possible to identify the critical share of the non-acid reflux, i.e. mixed (21%) or alkaline (6%). Episodes of non-acid reflux feature a significantly higher rate of association with pain than acid reflux (12.5% of symptomatic acid refluxes, versus 6% of symptomatic acid refluxes, versus 6% of mixed refluxes and 7.15% of alkaline refluxes). Execution of an ergometric test, performed according to routine cardiologic procedures during pH monitoring, constitutes a valid stimulation for reflux-dependent pain, enabling us to achieve a diagnostic gain of 15.5% compared to pH monitoring alone. As stated, elicitation of pain by motor causes is performed using endo-esophageal distension (positive in 30% of cases) and with electrostimulation, a new test studied at our center.(ABSTRACT TRUNCATED AT 250 WORDS)