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Q J Med 2000; 93: 543-550
© 2000 Association of Physicians

Commentary Papers

Are oesophageal disorders a common cause of chest pain despite normal coronary anatomy?

E.B. Wu, R. Cooke, A. Anggiansah1, W. Owen1 and J.B. Chambers

From the Cardiothoracic Centre and 1 Oesophageal Investigation Unit, Guy's and St Thomas' Hospital, London, UK

Introduction

On average 20%, but up to 39%, of patients undergoing coronary angiography for the investigation of chest pain are found to have normal coronary anatomy.1 These patients have a cardiac morbidity and mortality close to the normal population on short- or long-term follow-up,2 and the tendency is to reassure and discharge them from follow-up. However, 50% continue to have chest pain and 50% remain or become unemployed (Table 1Go), therefore an effort should be made to make a positive diagnosis in order to start appropriate treatment. Abnormal oesophageal motility or reflux are found frequently in these patients (Tables 2Go and 3Go), but how often these are causative remains uncertain.


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  		Table 1 Follow-up studies in patients with non-cardiac chest pain.

 

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  		Table 2 Results of static manometry studies in patients with non-cardiac chest pain.

 

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  		Table 3 Differences in analysis between different studies using ambulatory monitoring.

 

How good is the evidence for an oesophageal origin for chest pain?

Acid reflux
A number of studies have shown a high incidence of abnormal . . . [Full Text of this Article]

Motility disorders
Provocative tests
Why is the association between chest pain and oesophageal abnormalities sometimes weak?

Conclusions

Notes

References


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A. Phan, C. Shufelt, and C. N. B. Merz
Persistent Chest Pain and No Obstructive Coronary Artery Disease
JAMA, April 8, 2009; 301(14): 1468 - 1474.
[Abstract] [Full Text] [PDF]