Unexplained chest pain: the hypersensitive, hyperreactive, and poorly compliant esophagus

Area of Science:

• Gastroenterology
• Esophageal Physiology
• Pain Medicine

Background:

• Chest pain is a common symptom with various causes.
• In some patients, cardiac and standard esophageal evaluations do not identify a cause for chest pain.
• Esophageal neuromuscular dysfunction is a potential, yet under-investigated, cause of such symptoms.

Purpose of the Study:

• To investigate if esophageal neuromuscular dysfunction is the cause of chest pain in patients with normal cardiac and esophageal work-ups.
• To utilize a novel technique to assess esophageal sensory, motor, and biomechanical properties.

Main Methods:

• A prospective study was conducted at a tertiary referral center.
• 24 patients with unexplained chest pain and 12 healthy controls were enrolled.
• Impedance planimetry was used to measure esophageal pressure, cross-sectional areas, and biomechanical variables.

Main Results:

• Patients reported pain at significantly lower balloon distention pressures compared to controls.
• 83% of patients experienced typical chest pain reproduction during the procedure.
• Patients exhibited increased esophageal reactivity, higher pressure elastic modulus, and reduced esophageal compliance.

Conclusions:

• Esophageal impedance planimetry can reproduce pain in patients with unexplained chest pain.
• These patients demonstrate a lower sensory threshold for pain and reactive contractions.
• Reduced esophageal compliance and heightened neuromuscular reactivity are associated with unexplained chest pain.