Upper endoscopy in patients with angina and normal coronary angiograms

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.

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.

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%.

The study provides evidence that routine esophagogastroduodenoscopy is of limited value in this group of patients.