Alimentary TractSustained esophageal contraction: A marker of esophageal chest pain identified by intraluminal ultrasonography☆,☆☆,★
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.
Variable Value No. of subjects 10 Age (yr)a 43.4 ± 11.2 (25–66) Duration of symptoms (yr)a 3.9 ± 3.6 (0.5–10) Loss of work time due to chest pain, n 4 Hospitalization or ER visit for pain, n 8 Failed trial of acid suppression, n 9 Cardiac evaluation, nb 8 Exercise treadmill 6 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).
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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.
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The authors report no conflict of interest with any device or pharmaceutical product described in this manuscript.