'Esophageal angina' as the cause of chest pain

One hundred consecutive medical emergency patients with anterior chest pain were followed to their final diagnosis to discover the prevalence of esophageal disease as the cause of anginal pain. Seventy-seven of the patients had pain that was anginal in character, and one fifth of these (16 patients) had abnormalities demonstrated by the following esophageal investigations: endoscopy with biopsy, manometry, radiology, and acid perfusion. The 16 patients whose anginal pain was thought to be due to esophageal disease all performed normally on an exercise tolerance test, and in eight of them the association between the esophagus and their symptoms was demonstrated by a positive provocation test result: esophageal acid perfusion was the most useful investigation in this group.