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Upper endoscopy in patients with angina and normal coronary angiograms
O Frøbert1, P Funch-Jensen, N O Jacobsen
1Department of Cardiology, Skejby University Hospital, Aarhus, Denmark.
Insights
Routine upper endoscopy offers limited value for patients with angina and normal coronary angiograms. This diagnostic approach infrequently identifies significant esophageal abnormalities or gastroesophageal reflux disease in this population.
Area of Science:
- Gastroenterology
- Cardiology
- Diagnostic Endoscopy
Background:
- Patients with angina and normal coronary angiograms often undergo esophagogastroduodenoscopy (upper endoscopy) before further esophageal investigations.
- The clinical utility of this recommended endoscopic evaluation in this specific patient cohort remains under investigation.
Purpose of the Study:
- To assess the diagnostic value of upper endoscopy in patients presenting with angina-like chest pain and normal coronary angiograms.
- To determine the prevalence of esophageal abnormalities and gastroesophageal reflux disease (GERD) in this patient group.
Main Methods:
- A prospective study included 49 patients with angina-like chest pain and normal coronary angiograms.
- Upper endoscopy with esophageal biopsies and 24-hour pH monitoring were performed.
- Patients completed a follow-up questionnaire after a median of 36 months.
Main Results:
- Esophagitis was diagnosed in 31% (macroscopic) and 25% (microscopic) of patients.
- Peptic ulcers were found in 6% of patients; only one patient had an abnormal 24-hour pH monitoring result.
- Acid-suppressing treatment provided symptom relief in only 4% of patients.
Conclusions:
- Routine esophagogastroduodenoscopy provides limited clinical value for patients with angina and normal coronary angiograms.
- The findings suggest that upper endoscopy is not a highly effective diagnostic tool for this patient population.
Background And Study Aims:
It has been recommended that patients with angina, a normal coronary angiogram, and no other signs of heart disease, should be evaluated using esophagogastroduodenoscopy before referral to dynamic esophageal investigations. The aim of the present study was to investigate the clinical value of upper endoscopy in this patient group.
Patients And Methods:
Forty-nine consecutive patients (28 women aged 18-70 years, mean 51.6 years) with angina-like chest pain and a normal coronary angiogram, who were referred to a tertiary cardiologic center, were included in a prospective study. Upper endoscopy with distal esophageal biopsies was performed. The results were compared with 24-hour pH monitoring. At a median of 36 months after discharge, the patients were asked to complete a follow-up questionnaire.
Results:
Macroscopic esophagitis was found in 15 patients (31%), and microscopic esophagitis in 11 (25% of the patients who underwent esophageal biopsy). One patient had macroscopic grade II esophagitis, and the rest had grade I esophagitis. The only major abnormalities were three peptic ulcers (6%). Five patients had symptoms of gastroesophageal reflux, but the 24-hour pH monitoring revealed an abnormal reflux index in only one. The median reflux index was 1.3 (range 0.0-13.4) in the patient group and 2.1 (range 0.0-9.9) in a control group (n = 22; p = 0.49). Patients with positive and normal exercise electrocardiography did not differ in terms of the endoscopic findings or reflux index. At the post-study follow-up, 38% of the patients had undergone acid secretion inhibitor treatment, with an effect on symptoms in only 4%.
Conclusions:
The study provides evidence that routine esophagogastroduodenoscopy is of limited value in this group of patients.