[Diagnosis and treatment of angina-like chest pain in 52 cases]

Esophageal investigation was performed successfully in 52 patients who were initially suspected of suffering from angina pectoris, but the pain was subsequently shown to be not of cardiac origin by radionuclide myocardiac perfusion and (or) coronary angiography in 74% of cases, and by EKG and poor response to anti-angina therapy in 26% of the cases. In 82.7% of the patients the diagnosis was gastroesophageal reflux disease (GERD), in 3.8% Nutcracker esophagus, and in 5.8% lower esophageal sphinctor hypertension. In the remaining 7.7% the diagnosis was unknown. In 43 patients with GERD, gastroesophageal reflux (GER) investigation showed GER symptoms in 61.5%, reflux esophagitis was confirmed with endoscopy in 45.3%. Abnormal esophageal manometry was found in 53.8%, positive provocative test in 42.9%, excessive radionuclide GER in 50%, and increased duration of hyperacidity in 57.1%. However, a combined study of the procedures mentioned above showed that the diagnosis was consistent with GERD in 82.3% of the patients. Chest pain was completely relieved in 34% of the cases and significantly relieved in 50%. No response was ilicited in 16% of the cases after 1-2 weeks of anti-reflux therapy. It is found that chest pain induced by GERD is very common, esophageal endoscopy and motor studies are helpful in the diagnosis of GERD and other esophageal motor diseases, and anti-reflux therapy is a reliable measure when a patient complains of unknown chest pain and GER symptoms.