Esophageal Visceral Hypersensitivity and Compliance in Patients with Unexplained Moncardiac Chest Pain

Paik, Seung Woon; Rhee, Jong Chul; Kim, Jae Jun; Koh, Kwang Cheol; Lee, Hwa Young; Rhee, Poong Lyul; Jeon, Seong Gook; Kang, In Koo

Abstract

BACKGROUND AND AIMS: Reduced visceral pain threshold as a cause of noncardiac chest pain is a subject of controversy. Compliance and pain perception are different in the smooth and striated muscle segments of the esophagus. The aim of this study is to evaluate the difference in visceral pain threshold and compliance of the upper and lower esophagus between patients with unexplained noncardiac chest pain and healthy controls.
METHODS
We examined 8 healthy controls (3 male, rnean age: 24.5 years) and 8 patients with chest pain (3 male, mean age: 51.5 years) who were normal in coronary angiography or exercise myocardium perfusion scan and show normal finding on EGD, esophageal manometry and 24-hr esophageal pH monitoring. Intraesophageal balloon was placed at 5 cm above LES. Symptoms and intraballoon volumes were recorded while intaballoon pressure was increased in 1 mmHg increments using Barostat system (Distender series II). The above measurernents were repeated after the balloon was positioned 5 cm below UES. Compliance was also measured.
RESULTS
1) At initial perception, intraballoon pressure (mmHg) of the upper and lower esophagus was not significantly different between the patients group (3.9+/-2.0, 6.5+/-4.7 respectively) and the control group (3.8+/-1.3, 6.5+/-3.0). Intraballoon volumes (ml) were not significantly different between patients (14.5+/-6.5, 22.0+/-10.2) and controls (11.5+/-2.8, 18.8+/-11.7). 2) During chest pain, intraballoon pressure (mmHg) of the upper and lower esophagus was not significantly different between patients (9.0+/-3.9, 17.6+/-9.6 respectively) and the controls (8.5+/-3.2, 12.9+/-3.2). Intraballoon volume (ml) was not significantly different between the patients (30.8+/-17.0, 62.9+/-32.0) and the controls (27.6+/-10.6, 44.6+/-15.4). 3) Esophageal compliance (ml/mmHg) of the upper and lower esophagus was not significantly different between patients (3.6+/-1.3, 3.9+/-2.3) and controls (3.1+/-0.3, 3.2+/-0.9).
CONCLUSIONS
There was no difference in the visceral sensitivity and compliance of the upper and lower esophagus between patients with unexplained noncardiac chest pain and healthy controls.