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[Esophageal diseases in patients with stenocardia and angiographically changes and little-changed coronary arteries]
Insights
Many patients with chest pain have normal coronary arteries. Esophageal issues, not heart problems, may cause persistent chest pain, suggesting esophageal functional studies are crucial for diagnosis.
Area of Science:
- Cardiology
- Gastroenterology
Background:
- Persistent chest pain is a common clinical presentation.
- Coronary artery disease is a primary suspect in anginal patients.
- Refractory chest pain necessitates exploring alternative diagnoses.
Purpose of the Study:
- To investigate the prevalence of esophageal lesions in patients presenting with angina and unaffected coronary arteries.
- To evaluate the role of esophageal dysfunction in persistent chest pain unresponsive to antianginal therapy.
Main Methods:
- Coronary angiography was performed on 29 patients with angina.
- Myocardial scintigraphy, bicycle ergometry, and 24-hour ECG monitoring were used to assess for myocardial ischemia.
- Esophageal evaluation included endoscopy, manometry, and esophageal pH-metry with the Bernstein test.
Main Results:
- Coronary arteries were intact in 23 of 29 patients (79%).
- Myocardial ischemia signs were detected in 17 patients (59%).
- Esophageal lesions were confirmed in 20 examinees (68%), with the Bernstein test being positive in this group.
Conclusions:
- A significant proportion of patients with angina and normal coronary arteries exhibit esophageal lesions.
- Esophageal dysfunction should be considered in the differential diagnosis of persistent chest pain, especially when unresponsive to standard antianginal treatments.
- Functional esophageal studies are recommended for patients with refractory chest pain and normal coronary arteries.
Abstract:
Angiography conducted in 29 anginal patients has shown that coronary arteries were intact in 23 and little affected in 6 of them. Signs of myocardial ischemia were recorded at myocardial scintigraphy, bicycle ergometry, 24-h ECG monitoring in 17 patients. Esophageal lesions confirmed by endoscopy, manometry, esophageal pH-metry with Bernstein test were revealed in 20 examinees (68%). It is suggested that patients with persistent chest pain and unaffected coronary arteries who are resistant to antianginal therapy should undergo functional study of the esophagus including endoscopy, manometry and pH-metry.