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Edward G. Hewson, FRACP; Chris B. Dalton, PA-C; Barry T. Hackshaw, MD; Wallace C. Wu, MBBS; Joel E. Richter, MD

Arch Intern Med. 1990;150(5):965-969.

Abstract
• The purpose of our study was to assess the prevalence of esophageal test abnormalities in patients with known cardiovascular disease and persistent chest pain. We performed a retrospective review of symptoms, manometry, and provocative test results performed on patients with undiagnosed chest pain. The 220 patients with angiographically determined cardiac disease and persistent chest pain were divided into three groups: coronary artery disease (125 patients), mitral valve prolapse (38 patients), and coronary bypass/angioplasty (57 patients). A comparison group consisted of 159 patients with noncardiac chest pain. All patients underwent esophageal manometry and placebo-controlled provocative testing (acid perfusion test and edrophonium chloride test). The prevalence of esophageal motility disorders in the noncardiac chest pain group (27%) was similar to that in the coronary artery disease (24%), mitral valve prolapse (37%), and coronary bypass/angioplasty (30%) groups. The frequency of nutcracker esophagus (11% to 16%) and diffuse esophageal spasm (2% to 7%) was remarkably constant. The prevalence of any positive provocative result in the noncardiac chest pain group (27%) was similar to that in the coronary artery disease (19%), mitral valve prolapse (32%), and coronary bypass/ angioplasty (20%) groups. Furthermore, completely negative results of esophageal investigation occurred in 55%, 62%, 42%, and 59% of the respective patient groups.

(Arch Intern Med. 1990;150:965-969)

Author Affiliations
From the Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC. Dr Hewson is now with the Royal Newcastle (Australia) Hospital.

Footnotes
Accepted for publication December 4,1989.

Reprint requests to Division of Gastroenterology, University of Alabama at Birmingham, UAB Station, Birmingham, AL 35294 (Dr Richter).

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