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Unexplained Noncardiac Chest Pain
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
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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.
Ronnie Fass, MD
Tucson Veterans Affairs Medical Center; Tucson, AZ 85723
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
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