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[Atypical chest pain: study by the hydrochloric acid provocation test].
B Salis Graciela1, J C Chiocca, J Marcarián
1Servicio de Gastroenterología, Hospital Nacional Profesor Alejandro Posadas, Provincia de Buenos Aires, Argentina.
Acta Gastroenterologica Latinoamericana
|January 1, 1990
Summary
Gastroenterological issues, not coronary artery disease, often cause chest pain in patients. Esophageal manometry revealed abnormal esophageal motility in most patients, suggesting a non-cardiac origin for their chest pain.
Area of Science:
- Gastroenterology
- Cardiology
- Physiology
Context:
- Chest pain is a common symptom with diverse origins, often necessitating differentiation between cardiac and non-cardiac causes.
- Patients with chest pain frequently undergo cardiological evaluation, including coronary arteriography, to rule out coronary artery disease.
- Gastrointestinal disorders, particularly esophageal dysfunction, are increasingly recognized as significant contributors to chest pain presentations.
Purpose:
- To investigate the origin of chest pain (CP) in patients with both normal and pathological coronary arteries.
- To evaluate the role of esophageal manometry (EM) and provocative testing in diagnosing the cause of chest pain.
- To correlate esophageal motility patterns and responses to provocative tests with coronary arteriogram findings.
Summary:
- This study utilized esophageal manometry, electrocardiography (ECG), and heart rate/pressure product (RPP) monitoring in patients experiencing chest pain.
- Abnormal basal esophageal manometry findings, including increased wave pressure and aperistaltic waves, were observed in 61.9% of patients.
- A positive response to the hydrochloric acid provocative test occurred in 14.2% of patients, with the heart rate/RPP relationship being the only statistically significant finding.
Impact:
- Highlights the significant prevalence of esophageal motility disorders in patients presenting with chest pain, even those with normal coronary arteries.
- Suggests that esophageal manometry is a valuable tool for identifying non-cardiac causes of chest pain.
- Recommends further research combining 24-hour esophageal manometry and pH monitoring with more sensitive provocative tests like edrophonium chloride for comprehensive diagnosis.