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Systematic Esophageal Evaluation of Patients With Noncardiac Chest Pain
Sarkis J. Chobanian, MD;
Stanley B. Benjamin, MD;
David J. Curtis, MD;
Edward L. Cattau, Jr, MD
Arch Intern Med. 1986;146(8):1505-1508.
Abstract
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• We prospectively studied 73 patients with anginalike chest pain severe enough to warrant admission to a coronary care unit over a five-month period. Thirty-four patients (47%) were found to have coronary artery disease as the cause of their symptoms, based on exercise testing, stress radionuclide imaging, or cardiac catheterization. The remaining 39 patients had normal cardiac findings and then underwent videoesophagography, radionuclide esophageal transit study, and esophageal manometry. Thirty-three of the 39 underwent acid perfusion testing (modified Bernstein's test). The findings at esophageal manometry were abnormal in 29 (74%) of 39. Manometric diagnoses were "nutcracker esophagus" in 17 (59%), nonspecific esophageal motility disorders in nine (31%), diffuse esophageal spasm in two (7%), and achalasia in one (3%). Bernstein's test reproduced symptoms in only 12%. The sensitivity of videoesophagography in detecting esophageal motility disorders was 66%, and that of radionuclide esophageal transit was 79%. The positive predictive values were 86% and 85%, respectively.
(Arch Intern Med 1986;146:1505-1508)
Author Affiliations
From the Departments of Medicine (Drs Chobanian, Benjamin, and Cattau) and Radiology (Dr Curtis), Naval Hospital, and the Uniformed Services University of the Health Sciences, Bethesda, Md. Drs Benjamin and Cattau are now with the Department of Gastroenterology, Georgetown University Hospital, Washington, DC, and Dr Curtis is now with the Department of Radiology, George Washington University Hospital.
Footnotes
Accepted for publication Nov 1, 1985.
Read before the 84th Annual Meeting of the American Gastroenterological Association, Washington, DC, May 24, 1983.
The opinions and assertions contained herein are the private ones of the authors and are not to be construed as official or as reflecting the views of the Department of Defense, the Department of the Navy, or the Uniformed Services University of the Health Sciences.
Reprint requests to Box 342, Naval Hospital, Bethesda, MD 20814-5011 (Dr Chobanian).
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