LETTER
Unexplained Noncardiac Chest Pain
Ronnie Fass, MD
15 April 1997 | Volume 126 Issue 8 | Page 662
TO THE EDITOR:
I read with great interest the recent article by Rao and colleagues [1]. However, I have several methodologic concerns that could affect the results of this study. When esophageal sensory perception thresholds are assessed, general or local anesthesia should be avoided. Local anesthesia, which can be swallowed and can potentially alter esophageal perception, was used in this study.
In addition, the authors used pressure to determine thresholds of esophageal perception. We have found that pressure is a much less accurate variable than volume because it is greatly influenced by esophageal contractions in response to balloon distention [2]. These contractions increase in amplitude in direct relation to the amount of air or liquid that is introduced, resulting in great variability in the end point measurement. Finally, slow-ramp distention was used to determine perception thresholds (sensory threshold, moderate discomfort, and pain). This technique has several shortcomings.
Differentiation between moderate discomfort and pain is subjective. Moreover, no attempt was made to track reported perception thresholds (within patients at one setting), and reproducibility of sensory perception over time is lacking. An alternate and more reliable method is an interactive tracking paradigm for predetermined sensory perceptions. It should be emphasized that reports of esophageal sensation are subjective and that efforts should be made to establish reliability.
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Author and Article Information
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Tucson Veterans Affairs Medical Center, Tucson, AZ 85723
1. Rao SS, Gregersen H, Hayek B, Summers RW, Christensen J. Unexplained chest pain: the hypersensitive, hyperreactive, and poorly compliant esophagus. Ann Intern Med. 1996; 124:950-8.
2. Fass R, Munakata J, Nabiloff B, Syntik B, Kodner A, Perez M, et al. Characterization of esophageal afferent function in healthy normal subjects. Am J Gastroenterol. 1995; 90:1574.
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