A useful method to diagnose chest pain with foregut symptoms
Recent reports have indicated that recurrent chest pain is often a result of esophageal motility disorders or gastroesophageal reflux diseases (GERD), which is known as esophageal chest pain. However, very few studies have been performed about esophageal manometric studies, 24-h intra-esophageal pH monitoring and a Holter electrocardiography for the differential diagnosis of chest pain caused by esophageal dysfunctional and/or myocardial ischemia. A research team led by Prof. Ru Wen Wang from China addressed this question. Their study will be published on February 14, 2009 in the World Journal of Gastroenterology.
In their study, 61 patients with chest pain and foregut symptoms were included. Thirty-nine patients were diagnosed with non-specific esophageal motility disorders (29 patients with abnormal gastroesophageal reflux and eight patients with myocardial ischemia). Five patients had diffuse spasm of the esophagus plus abnormal gastroesophageal reflux (two patients had concomitant myocardial ischemia), and one patient was diagnosed with nutcracker esophagus.
The study indicated that spasm of the esophageal smooth muscle might cross talk with the heart-coronary smooth muscle, leading to myocardial ischemia. And the combination of esophageal manometric studies, 24-hour intraesophageal pH monitoring and Holter electrocardiography are significant for the differential diagnosis of chest pain, particularly with foregut symptoms. As an added incentive, combined monitoring is very cost-effective to the patients from developing country.