Diagnostic utility of the oesophageal balloon distension test in the evaluation of oesophageal chest pain

I. Nasr, A. Attaluri, E. Coss-Adame, Satish Sanku Chander Rao

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background Oesophageal balloon distension test (EBDT) has been advocated for the evaluation of functional oesophageal noncardiac chest pain (NCCP), but its diagnostic utility remains unclear. Aim To prospectively assess the diagnostic yield of EBDT in clinical practice and compare its yield with standard oesophageal tests. Methods Over a period of 6 years, patients with chest pain and negative cardiac work-up underwent sequential testing with endoscopy/biopsy, oesophageal manometry, 24 h pH study and EBDT to elucidate an oesophageal source for their symptoms. Patients with a definite abnormality, for example, erosive oesophagitis on oesophagogastroduodenoscopy (EGD) were designated as having positive test and excluded from further work up. Results Of 348 (m/f = 105/243) suspected NCCP patients, 16 (5%) were excluded; 332 (95%) underwent oesophageal testing. Among these, 48 (14%) had macro/microscopic oesophagitis on endoscopy, 7 (2%) had achalasia and 96 (28%) had excessive acid reflux (pH study). The remaining 181 (52%) patients underwent EBDT; 128 (37%) had oesophageal hypersensitivity. Chest pain was reproduced in 97/128 (75%) subjects. There were no adverse effects. Conclusions Oesophageal testing can reveal an oesophageal source for chest pain in 86% of NCCP subjects. The majority (42%) of patients had gastro-oesophageal reflux disease (GERD). Oesophageal balloon distension test identified hypersensitivity in over one-third of subjects. The oesophageal balloon distension test provides useful diagnostic information and should be performed routinely in patients with NCCP after excluding GERD.

Original languageEnglish (US)
Pages (from-to)1474-1481
Number of pages8
JournalAlimentary Pharmacology and Therapeutics
Volume35
Issue number12
DOIs
StatePublished - Jun 1 2012

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Chest Pain
Esophageal Diseases
Esophagitis
Gastroesophageal Reflux
Endoscopy
Hypersensitivity
Digestive System Endoscopy
Esophageal Achalasia
Manometry
Biopsy
Acids

ASJC Scopus subject areas

  • Pharmacology (medical)

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Diagnostic utility of the oesophageal balloon distension test in the evaluation of oesophageal chest pain. / Nasr, I.; Attaluri, A.; Coss-Adame, E.; Rao, Satish Sanku Chander.

In: Alimentary Pharmacology and Therapeutics, Vol. 35, No. 12, 01.06.2012, p. 1474-1481.

Research output: Contribution to journalArticle

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abstract = "Background Oesophageal balloon distension test (EBDT) has been advocated for the evaluation of functional oesophageal noncardiac chest pain (NCCP), but its diagnostic utility remains unclear. Aim To prospectively assess the diagnostic yield of EBDT in clinical practice and compare its yield with standard oesophageal tests. Methods Over a period of 6 years, patients with chest pain and negative cardiac work-up underwent sequential testing with endoscopy/biopsy, oesophageal manometry, 24 h pH study and EBDT to elucidate an oesophageal source for their symptoms. Patients with a definite abnormality, for example, erosive oesophagitis on oesophagogastroduodenoscopy (EGD) were designated as having positive test and excluded from further work up. Results Of 348 (m/f = 105/243) suspected NCCP patients, 16 (5{\%}) were excluded; 332 (95{\%}) underwent oesophageal testing. Among these, 48 (14{\%}) had macro/microscopic oesophagitis on endoscopy, 7 (2{\%}) had achalasia and 96 (28{\%}) had excessive acid reflux (pH study). The remaining 181 (52{\%}) patients underwent EBDT; 128 (37{\%}) had oesophageal hypersensitivity. Chest pain was reproduced in 97/128 (75{\%}) subjects. There were no adverse effects. Conclusions Oesophageal testing can reveal an oesophageal source for chest pain in 86{\%} of NCCP subjects. The majority (42{\%}) of patients had gastro-oesophageal reflux disease (GERD). Oesophageal balloon distension test identified hypersensitivity in over one-third of subjects. The oesophageal balloon distension test provides useful diagnostic information and should be performed routinely in patients with NCCP after excluding GERD.",
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N2 - Background Oesophageal balloon distension test (EBDT) has been advocated for the evaluation of functional oesophageal noncardiac chest pain (NCCP), but its diagnostic utility remains unclear. Aim To prospectively assess the diagnostic yield of EBDT in clinical practice and compare its yield with standard oesophageal tests. Methods Over a period of 6 years, patients with chest pain and negative cardiac work-up underwent sequential testing with endoscopy/biopsy, oesophageal manometry, 24 h pH study and EBDT to elucidate an oesophageal source for their symptoms. Patients with a definite abnormality, for example, erosive oesophagitis on oesophagogastroduodenoscopy (EGD) were designated as having positive test and excluded from further work up. Results Of 348 (m/f = 105/243) suspected NCCP patients, 16 (5%) were excluded; 332 (95%) underwent oesophageal testing. Among these, 48 (14%) had macro/microscopic oesophagitis on endoscopy, 7 (2%) had achalasia and 96 (28%) had excessive acid reflux (pH study). The remaining 181 (52%) patients underwent EBDT; 128 (37%) had oesophageal hypersensitivity. Chest pain was reproduced in 97/128 (75%) subjects. There were no adverse effects. Conclusions Oesophageal testing can reveal an oesophageal source for chest pain in 86% of NCCP subjects. The majority (42%) of patients had gastro-oesophageal reflux disease (GERD). Oesophageal balloon distension test identified hypersensitivity in over one-third of subjects. The oesophageal balloon distension test provides useful diagnostic information and should be performed routinely in patients with NCCP after excluding GERD.

AB - Background Oesophageal balloon distension test (EBDT) has been advocated for the evaluation of functional oesophageal noncardiac chest pain (NCCP), but its diagnostic utility remains unclear. Aim To prospectively assess the diagnostic yield of EBDT in clinical practice and compare its yield with standard oesophageal tests. Methods Over a period of 6 years, patients with chest pain and negative cardiac work-up underwent sequential testing with endoscopy/biopsy, oesophageal manometry, 24 h pH study and EBDT to elucidate an oesophageal source for their symptoms. Patients with a definite abnormality, for example, erosive oesophagitis on oesophagogastroduodenoscopy (EGD) were designated as having positive test and excluded from further work up. Results Of 348 (m/f = 105/243) suspected NCCP patients, 16 (5%) were excluded; 332 (95%) underwent oesophageal testing. Among these, 48 (14%) had macro/microscopic oesophagitis on endoscopy, 7 (2%) had achalasia and 96 (28%) had excessive acid reflux (pH study). The remaining 181 (52%) patients underwent EBDT; 128 (37%) had oesophageal hypersensitivity. Chest pain was reproduced in 97/128 (75%) subjects. There were no adverse effects. Conclusions Oesophageal testing can reveal an oesophageal source for chest pain in 86% of NCCP subjects. The majority (42%) of patients had gastro-oesophageal reflux disease (GERD). Oesophageal balloon distension test identified hypersensitivity in over one-third of subjects. The oesophageal balloon distension test provides useful diagnostic information and should be performed routinely in patients with NCCP after excluding GERD.

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