Esophageal Motility and Reflux Diseases in Patients with Noncardiac Chest Pain

Rhee, Poong Lyul; Rhee, Jong Chul; Kim, Young Ho; Son, Hee Jung; Kim, Jae Jun; Paik, Seung Woon; Choi, Kyoo Wan; Koh, Kwang Cheol; Lee, Hwa Young; Choi, Moon Seok; Jun, Sung Kuk; Sohn, Chong Il; Lee, Suk Ho

Abstract

BACKGROUND/AIMS: Some patients complaining chest pain have normal coronary angiograms. In these cases of noncardiac chest pain, esophageal disease might be a reasonable explanation. However, causal relationship between esophageal motility or reflux disease and chest pain may be difficult to be proven. Therefore, we performed this study to evaluate the esophageal abnormality as a potential cause of noncardiac chest pain.
METHODS
We underwent esophagogastroduodenoscopy, esophageal mancenetry and 24 hour esophageal pH monitoring in 58 patients with chest pain and normal coronary arteriogram or negative thallium study.
RESULTS
Of 58 patients, 17 patients (29.3%) had abnormal esophageal manometry test. There were 6 cases of nonspecific esophageal motility disorder, 5 cases of hypertensive lower esophageal sphincter, 5 cases of diffuse esophageal spasm and 1 case of nutcracker esophagus. In 56 patients with 24 hour pH monitoring, 13 patients had positive DeMeester score and 29 patients experienced chest pain during the test period. 11 patients (18.9%) had both positive DeMeester score and chest pain. Mean symptom index of these patients was 70.0% (range 40-100%).
CONCLUSIONS
Esophageal motility disorders and gastroesophegeal reflux diseases were frequantly found in patients with noncardiac chest pain. Much efforts should be made to find esophageal cause in patients with noncardiac chest pain.