New provocative tests in the diagnosis of esophageal chest pain

In the present experience, two new provocative tests are proposed in the diagnosis of chest pain. Exertional pHmetry, consisting in a standard ergometric test during esophago-gastric pHmetry, is employed in the diagnosis of chest pain by gastroesophageal reflux. 67 patients with non-cardiac chest pain were submitted to the test: 46 (group A) presenting pain only at rest, and 21 (group B) with exertional or mixed type of pain. Out of group A, 12 (25%) patients presented a positive response (both gastroesophageal reflux and typical pain during exercise). Out of group B, 6 (28.5%) patients responded positively, too. The diagnostic advantage of exertional pHmetry, compared to prolonged pHmetry, amounts to 21.7%. Exertional pHmetry, repeated on the following day, showed that occurrence of gastroesophageal reflux and pain are reproducible in all patients, with occurrence at the same threshold of the first test in 11 (61.1%) out of 18 patients. Endo-esophageal electrical stimulation is employed in the diagnosis of chest pain by motility disturbances: the technique is the same one of cardiological transesophageal atrial pacing. 6 healthy subjects and 21 patients with non-cardiac chest pain negative to other esophageal investigations (7 with and 14 without gastroesophageal reflux disease) were submitted to the test. 9 (43%) out of 21 patients showed a positive response, while in 2 patients (9%) we observed manometric changes without pain, and 10 (48%) showed a negative response. All the control subjects submitted to the test showed a completely negative response.(ABSTRACT TRUNCATED AT 250 WORDS)