Unexplained chest Pain: The hypersensitive, hyperreactive, and poorly compliant esophagus

Satish Sanku Chander Rao, Hans Gregersen, Bernard Hayek, Robert W. Summers, James Christensen

Research output: Contribution to journalArticle

142 Scopus citations

Abstract

Objective: To determine whether neuromuscular dysfunction of the esophagus causes chest pain in patients in whom no disease is found on cardiac work-up, upper gastrointestinal endoscopy, esophageal manometry, and 24-hour pH studies. Design: Prospective study. Setting: Tertiary referral center. Patients: 24 consecutive patients and 12 healthy controls. Measurements: A new technique, impedance planimetry, was used to measure the sensory, motor, and biomechanical properties of the human esophagus. The impedance planimeter, which consists of a probe with four ring electrodes, three pressure sensors, and a balloon, simultaneously measures intraluminal pressure and crosssectional areas. This allows calculation of the biomechanical variables of the esophageal wall. Results: Stepwise balloon distentions from 5 to 50 cm H 2 O induced a first sensation at a mean pressure (± SD) of 15 ± 9 cm H 2 O in patients and 30 ± 11 cm H 2 O in controls (P < 0.001). Moderate discomfort and pain were reported by 20 of 24 patients (83%) at 26 ± 9 cm H 2 O and at 36 ± 9 cm H 2 O, respectively, but by none of the controls (P < 0.001). Typical chest pain was reproduced in 20 of 24 patients (83%). In patients, the reactivity of the esophagus to balloon distention was greater (P = 0.01), the pressure elastic modulus was higher (P = 0.02), and the tensionstrain association showed that the esophageal wall was less distensible (P = 0.02). Distention excited tertiary contractions and secondary peristalsis at a lower threshold of pressure (P = 0.05) and with a higher motility index in patients than in controls (P = 0.04). Conclusion: In patients with chest pain and normal cardiac and esophageal evaluations, impedance planimetry of the esophagus reproduces pain and is associated with a 50% lower sensory threshold for pain, a 50% lower threshold for reactive contractions, and reduced esophageal compliance.

Original languageEnglish (US)
Pages (from-to)950-958
Number of pages9
JournalAnnals of internal medicine
Volume124
Issue number11
DOIs
StatePublished - Jan 1 1996
Externally publishedYes

ASJC Scopus subject areas

  • Internal Medicine

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