Abstract
During the last five years, 672 patients were referred to our esophageal investigation unit; 110 patients (16.3%) of these presented with chest pain of undetermined etiology (CPUE) alone. Since the nature of this pain is intermittent and rarely present during the diagnostic study, acid perfusion and intravenous edrophonium tests were added as provocative tests after baseline esophageal manometry. Following completion of the motility studies, 24-hr pH study was performed to detect gastroesophageal reflux (GER). Twenty-nine patients (26.4%) had positive acid perfusion (APT) test whereas 26 patients (23.6%) had positive edrophonium test (ET). In the group of patients with positive acid perfusion test, 12/29 (41.3%) had GER, 8/29 (27.5%) had both motility disorder and GER, 2/29 (6.8%) had motility disorder, and 7/29 (24.1%) had normal esophageal motility and 24-hr pH studies. In the other group, 13/26 (50%) had motility disorder and 13/26 (50%) had both motility disorder and GER. There were no significant differences between the two tests as far as reproducibility of symptoms was concerned. We conclude that ATP and ET showed the esophageal origin of CPUE in half of our patients and therefore in a substantial percentage of patients the esophageal origin of chest pain will remain very diffcult to prove.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Blackwell JN, Castell DO: Oesophageal chest pain: a point of view. Gut 25:1–6, 1984
de Caestecker JS, Blackwell JN, Brown J, Heading RC: The oesophagus as a cause of recurrent chest pain: Which patients should be investigated and which tests should be used? Lancet 2:1143–1146, 1985
Brand DL, Martin D, Pope DE II: Esophageal manometrics in patients with angina-like chest. Am J Dig Dis 22:300–304, 1977
Anonymous: Angina and oesophageal disease [Leader]. Lancet 1: 191–192, 1986
Bernstein LM, Fruin RC, Pacini R: Differentiation of esophageal pain from angina pectoris: Role of the esophageal acid perfusion test. Medicine (Baltimore) 41:143–162, 1962
Bennett JR, Atkinson M: Oesophageal acid perfusion in the diagnosis of precordial pain. Lancet 2:1150–1152, 1966
Benjamin SB, Richter JE, Cordova CM, Knuff TE, Castell DO: Prospective manometric evaluation with pharmacologic provocation of patients with suspected esophageal motility dysfunction. Gastroenterology 84:893–901, 1983
Richter JE, Hackshaw BT, Wu WS, Castell DO: Edrophonium: A useful provocatine test for esophageal chest pain. Ann Intern Med 103:14–21, 1985
Linsell J, Owen WJ, Mason RC, Anggiansah A: Edrophonium provocation test in the diagnosis of diffuse oesophageal spasm. Br J Surg 74:688–689, 1987
Bernstein LM, Baker LA: A clinical test for esophagitis. Gastroenterology 34:760–781, 1958
Linsell J, Owen W, Anggiansah A: Management options for patients with diffuse esophageal spasm.In Diseases of the Esophagus. JR Siewert, AH Holscher (eds). New York, Springer-Verlang, 1987, pp 909–912
Brown PW, Hollander M: Statistics: A Biomedical Introduction. Wiley Series in Probability and Mathematical Statistics. New York, John Wiley & Sons, 1977
Behar J, Biancini P, Sheahan DG: Evaluation of esophageal tests in the diagnosis of reflux esophagitis. Gastroenterology 71:9–15, 1976
Richter JE: Acid perfusion (Bernstein) test.In Gastroesophageal Reflux Disease: Pathogenesis, Diagnosis, Therapy. DO Castell, WC Wu, DJ Ott (eds), Mt Kisco, New York, Futura, 1985, pp 139–148
Siegel CI, Hedrix TR: Esophageal motor abnormalities induced by acid perfusion in patients with heartburn. J Clin Invest 42:686–695, 1963
Baldi F, Ferrarini F, Balestra R, Borioni D, Longanesi A, Miglioli M, Barbera L: Oesophageal motor events at the occurrence of acid reflux and during endogenous acid exposure in healthy subjects and in patients with oesophagitis. Gut 26:336–341, 1985
Burns TW, Ventouratos SG: Esophageal motor function and response to acid perfusion in patients with symptomatic reflux esophagitis. Dig Dis Sci 30:529–535, 1985
Ghillebert G, Janssens J, Vantrappen G, Nevens F, Piessens J: Ambulatory 24 hour intraoesophageal pH and pressure recordings vs provocation tests in the diagnosis of chest pain of oesophageal origin. Gut 31:738–744, 1990
Lee CA, Reynolds JC, Ouyang A, Baker L, Cohen S: Esophageal chest pain: Value of high-dose provocative testing with edrophonium chloride in patients with normal esophageal monometrics. Dig Dis Sci 32:682–688, 1987
de Caestecker JS, Pryde A, Heading RC: Comparison of intravenous edrophonium and oesophageal acid perfusion during oesophageal manometry in patients with non-cardiac chest pain. Gut 29:1029–1034, 1988
Richter JE, Barish CF, Castell DO: Abnormal sensory perception in patients with esophageal chest pain. Gastroenterology 91:845–852, 1986
Rodrigo J, Nava BE, Pedrosa J: Study of vegetative innervation in the esophagus. 1. Perivascular endings. Trab Inst Cajal (Invest Bio) 62:39, 1970
MacKenzie J, Belch J, Park R, McKilip J: Oesophageal ischaemia in motility disorders associated with chest pain. Lancet 2:592–595, 1988
Vantrappen G, Janssens J, Ghillebert G: The irritable oesophagus—a frequent cause of angina-like pain. Lancet 1:1232–1234, 1987
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Rokkas, T., Anggiansah, A., McCullagh, M. et al. Acid perfusion and edrophonium provocation tests in patients with chest pain of undetermined etiology. Digest Dis Sci 37, 1212–1216 (1992). https://doi.org/10.1007/BF01296562
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01296562