TY - JOUR
T1 - Unexplained chest Pain
T2 - The hypersensitive, hyperreactive, and poorly compliant esophagus
AU - Rao, Satish Sanku Chander
AU - Gregersen, Hans
AU - Hayek, Bernard
AU - Summers, Robert W.
AU - Christensen, James
PY - 1996/1/1
Y1 - 1996/1/1
N2 -
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 crosssectional areas. This allows calculation of the biomechanical variables of the esophageal wall. Results: Stepwise balloon distentions from 5 to 50 cm H
2
O induced a first sensation at a mean pressure (± SD) of 15 ± 9 cm H
2
O in patients and 30 ± 11 cm H
2
O in controls (P < 0.001). Moderate discomfort and pain were reported by 20 of 24 patients (83%) at 26 ± 9 cm H
2
O and at 36 ± 9 cm H
2
O, 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 tensionstrain 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.
AB -
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 crosssectional areas. This allows calculation of the biomechanical variables of the esophageal wall. Results: Stepwise balloon distentions from 5 to 50 cm H
2
O induced a first sensation at a mean pressure (± SD) of 15 ± 9 cm H
2
O in patients and 30 ± 11 cm H
2
O in controls (P < 0.001). Moderate discomfort and pain were reported by 20 of 24 patients (83%) at 26 ± 9 cm H
2
O and at 36 ± 9 cm H
2
O, 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 tensionstrain 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.
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U2 - 10.7326/0003-4819-124-11-199606010-00002
DO - 10.7326/0003-4819-124-11-199606010-00002
M3 - Article
C2 - 8624062
AN - SCOPUS:0030317302
SN - 0003-4819
VL - 124
SP - 950
EP - 958
JO - Annals of internal medicine
JF - Annals of internal medicine
IS - 11
ER -