Gastroenterology

Gastroenterology

Volume 116, Issue 1, January 1999, Pages 29-37
Gastroenterology

Alimentary Tract
Sustained esophageal contraction: A marker of esophageal chest pain identified by intraluminal ultrasonography,☆☆,

https://doi.org/10.1016/S0016-5085(99)70225-8Get rights and content

Abstract

Background & Aims: Intraluminal pressure recording systems have not demonstrated predictable esophageal motor correlates of unexplained chest pain. This study used continuous high-frequency intraluminal ultrasonography to characterize esophageal contraction at the time of spontaneous and provoked chest pain. Methods: Intraluminal pressure, pH, and ultrasound images of the esophagus were recorded for a maximum of 24 hours in 10 subjects with unexplained chest pain. Changes in esophageal muscle thickness were measured as a marker of muscle contraction. Ten additional subjects with suspected esophageal chest pain were studied after edrophonium chloride injection to provoke symptoms. Ten healthy subjects were studied as controls. Results: Eighteen of 24 spontaneous chest pain episodes were preceded by a sustained esophageal contraction (SEC) detected on ultrasonography (mean duration, 68.0 seconds). This motor pattern was not accompanied by changes in intraluminal pressure. Four of 24 asymptomatic control periods were accompanied by SEC, although these contractions were of shorter mean duration (29.0 seconds; P < 0.001). SEC was observed in 5 subjects with a positive chest pain response to edrophonium and in none of the 5 subjects with a negative response. SEC was not detected in normal subjects. Conclusions: There is a strong temporal correlation between a previously unrecognized esophageal motor event, SEC, and both spontaneous and provoked esophageal chest pain.

GASTROENTEROLOGY 1999;116:29-37

Section snippets

Study of spontaneous chest pain events

Study subjects with unexplained chest pain were recruited from the University of Virginia Chest Pain Evaluation Center, the Diagnostic Cardiology Clinic, and the Gastroenterology Outpatient Clinic. Subjects were eligible for enrollment if they had chronic chest pain (>6 months) occurring at least once per day in the absence of a clearly definable cardiac, respiratory, or musculoskeletal cause. Cardiac testing, including angiography, treadmill exercise, radionuclide imaging, and/or

Study of spontaneous chest pain

Ten subjects (5 men and 5 women; mean age, 43.4 ± 11.2 years) were enrolled in the 24-hour study protocol. The baseline demographic features of the study group are shown in Table 1.

. Baseline data for 24-hour study subjects

VariableValue
No. of subjects10
Age (yr)a43.4 ± 11.2 (25–66)
Duration of symptoms (yr)a3.9 ± 3.6 (0.5–10)
Loss of work time due to chest pain, n4
Hospitalization or ER visit for pain, n8
Failed trial of acid suppression, n9
Cardiac evaluation, nb8
 Exercise treadmill6
 Coronary

Discussion

We used a novel technique, continuous HFIUS, in subjects with unexplained chest pain and detected a previously unrecognized motor pattern that was closely associated with chest pain. Eighteen of 24 spontaneous chest pain events were preceded by sustained thickening of the esophageal smooth muscle wall that was not detected by conventional esophageal pressure recordings. Similarly, edrophonium-induced chest pain was temporally associated with sustained esophageal muscular thickening. SECs were

Acknowledgements

The authors thank Sandy Murray, R.N., for performing the outpatient manometric studies and Eric Powers, M.D., Cardiac Catheterization Laboratory, for permitting use of the ultrasonography unit.

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    Supported by grant R01 DK51604-04A1 from the National Institutes of Health (to R.K.M.); a grant from the Jeffress Trust of Virginia; and by a General Clinical Research Center award (M01 RR00847).

    ☆☆

    Address requests for reprints to: Ravinder K. Mittal, M.D., Division of Gastroenterology, 111 D, San Diego Veterans Affairs Medical Center, 3350 La Jolla Village Drive, San Diego, California 92161. Fax: (619) 552-4327.

    The authors report no conflict of interest with any device or pharmaceutical product described in this manuscript.

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