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1 June 1996 | Volume 124 Issue 11 | Pages 950-958
Objective: To determine whether neuromuscular dysfunction of the esophagus causes chest pain in patients in whom no disease is found on cardiac work-up, upper gastrointestinal endoscopy, esophageal manometry, and 24-hour pH studies.
Design: Prospective study.
Setting: Tertiary referral center.
Patients: 24 consecutive patients and 12 healthy controls.
Measurements: A new technique, impedance planimetry, was used to measure the sensory, motor, and biomechanical properties of the human esophagus. The impedance planimeter, which consists of a probe with four ring electrodes, three pressure sensors, and a balloon, simultaneously measures intraluminal pressure and cross-sectional areas. This allows calculation of the biomechanical variables of the esophageal wall.
Results: Stepwise balloon distentions from 5 to 50 cm H2O induced a first sensation at a mean pressure (±SD) of 15 ± 9 cm H2O in patients and 30 ± 11 cm H2O in controls (P < 0.001). Moderate discomfort and pain were reported by 20 of 24 patients (83%) at 26 ± 9 cm H2O and at 36 ± 9 cm H2O, respectively, but by none of the controls (P < 0.001). Typical chest pain was reproduced in 20 of 24 patients (83%). In patients, the reactivity of the esophagus to balloon distention was greater (P = 0.01), the pressure elastic modulus was higher (P = 0.02), and the tension-strain association showed that the esophageal wall was less distensible (P = 0.02). Distention excited tertiary contractions and secondary peristalsis at a lower threshold of pressure (P = 0.05) and with a higher motility index in patients than in controls (P = 0.04).
Conclusion: In patients with chest pain and normal cardiac and esophageal evaluations, impedance planimetry of the esophagus reproduces pain and is associated with a 50% lower sensory threshold for pain, a 50% lower threshold for reactive contractions, and reduced esophageal compliance.
Author and Article Information
From the University of Iowa College of Medicine and Department of Veterans Affairs Medical Center, Iowa City, Iowa, and the University of Aarhus, Aarhus, Denmark.
ARTICLE
Unexplained Chest Pain: The Hypersensitive, Hyperreactive, and Poorly Compliant Esophagus
Acknowledgments: The authors thank L. Burmeister, PhD, for his assistance with the statistical analysis and D. Fujiwara, MD, for his help with the pilot studies.
Grant Support: In part by the 1994 American College of Gastroenterology Research Award and by the Merit Review funds from the Department of Veterans Affairs Medical Center.
Requests for Reprints: Satish S.C. Rao, MD, MRCP(UK), PhD, 4612 JCP, Internal Medicine Division, University of Iowa Hospitals and Clinics, Iowa City, IA 52242.
Current Author Addresses: Dr. Rao: Internal Medicine/GI Division, University of Iowa Hospitals and Clinics, 4612 JCP, Iowa City, IA 52242.
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