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Exertional esophageal pH-metry and manometry in recurrent chest pain Full Text
World Journal of Gastroenterology, 09/17/2010
Exclusive author commentary
Budzynski J – The presence of chest pain, esophageal acidification and EPES had greater than 80% specificity to exclude the GER–related and non–gastroesophageal reflux–related causes of recurrent chest pain.
Budzynski J (09/19/2010) comments:
Chest pain, including its angina-like form, is a common problem in health care because of its frequency, recurrence, the utilization of resources according to the cost of medical procedures, and diagnostic difficulties. According to current opinion, the sequence of procedures in the diagnosis of the cause of NCCP is as follows: empirical therapy with proton pump inhibitors (PPI); endoscopy; 24-hour oesophageal pH-metry or simultaneous examination of oesophageal impedance and pH-metry; stationary oesophageal manometry; 24-hour oesophageal manometry; as well as psychiatric examination. Pharmacological provocative tests have not been diagnostically useful, whereas the use the exercise in order to provoke symptoms in patients with reccurent chest pain suspected of being related to oesophageal motility disorders has not been sufficiently investigated. However, it is known that exercise may induce myocardial ischaemia as well as alterations in oesophageal motility, gastro-oesophageal reflux, and in such way reproduce chest pain. On the other hand, the main problem in diagnosis of chest pain originated from esophagus is confirmation of the association between occurence of symptoms and esophageal disroders. Such possibility seems to give the simultaneous monitoring of esophageal function and ECG during a treadmill stress test. Although, my investigation has shown, that patienst with reccurent chest pain in whom this symptom did not appear within cardiological work- up (i.e. treadmill stres test) have a little probability to reach clinically valuable gastroenterological diagnosis of chest pain. The practical message of my results is that among patienst with reccurent chest pain, non- responding to empirical therapy with proton pump inhibitor, it is worth to refer to gastroenterological work-up only ones with exercise provoked chest pain. This may shorten the diagnostic procedures time, save the resources and avoid unpleasant diagnostic procedures. On the other hand, patient should be informed that it is also possible that gastroenterological work-up may give EPES diagnose, which have favorable outcome therapy with calcium antagonist in 2,7 years follow-up, but this aspect will be presented in my next publication.
