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. 1998 Mar;42(3):323–329. doi: 10.1136/gut.42.3.323

A prospective study of oesophageal function in patients with normal coronary angiograms and controls with angina

R Cooke 1, A Anggiansah 1, J Chambers 1, W Owen 1
PMCID: PMC1727031  PMID: 9577335

Abstract

Aims—To compare the incidence of oesophageal abnormalities and their correlation with chest pain in patients with normal coronary angiograms, and in controls with angina. 
Patients—Sixty one patients with normal coronary angiograms (NCA group) referred to a single cardiac centre between March 1990 and April 1991; 25 matched controls with confirmed coronary artery disease (CAD group). 
Setting—Cardiac referral centre and oesophageal function testing laboratory. 
Main outcome measures—Oesophageal manometry, provocation tests, and 24 hour ambulatory pH monitoring. 
Results—Simultaneous contractions were more common (6.7% versus 0.8%, p<0.01), and the duration of peristaltic contractions was longer (2.9 versus 2.4 seconds, p<0.01) in the NCA group than in the CAD group. There were no group differences in the amplitude of peristaltic contractions, and none had nutcracker oesophagus. Ten (16%) patients with NCA and no patients with CAD had diffuse spasm (p=0.03). Twenty one (34%) patients with NCA, and five (20%) patients with CAD had abnormal gastro-oesophageal reflux (p>0.05). There was no significant difference between the groups in the number of patients whose pain was temporally related to pH events. Particular chest pain characteristics, or the presence of additional oesophageal symptoms, were not predictive of an oesophageal abnormality. 
Conclusion—Oesophageal function tests commonly implicate the oesophagus as a source of pain in patients with normal coronary angiograms. With the exception of simultaneous contractions during manometry however, the incidence of abnormalities and in particular the correlation of pH events with chest pain are as common in patients with normal coronary angiograms as in controls with angina. The oesophagus may often be an unrecognised source of pain in both groups of patients. 



Keywords: oesophageal function; coronary artery disease; chest pain

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Figure 1 .

Figure 1

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Comparison of distal peristaltic amplitude (DEA), duration (DED), and velocity (DEV) in NCA and CAD groups. *p<0.5.
NCA CAD p Value
DEA (mm Hg) 67.8 (29.4) 69.4 (25.6) 0.9
DED (s) 2.9 (0.7) 2.4 (0.4) <0.001
DEV (cm/s) 4.3 (1.2) 4.3 (1.2) 0.037
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Figure 2 .

Figure 2

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Comparison of parameters of gastro-oesophageal reflux during ambulatory pH monitoring: percentage reflux episodes.
Reflux episodes NCA CAD p Value*
Total number 20 (3.2 to 39.0) 12.0 (7.5 to 17.5) 0.3
Number >5 min 1.0 (0.0 to 5.0) 1.0 (0.0 to 3.0) 0.9
Longest duration 9.0 (1.2 to 21.7) 7.0 (5.0 to 15.0) 0.7
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Figure 3 .

Figure 3

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Comparison of parameters of gastro-oesophagel reflux during ambulatory pH monitoring: reflux episodes.
Per cent time pH <4 NCA CAD p Value*
Total (24 h) 1.9 (0.3 to 8.6) 1.3 (0.7 to 4.1) 0.90
Supine 0.5 (0.0 to 5.3) 0.0 (0.0 to 1.4) 0.09
Upright 2.3 (0.4 to 10.3) 1.8 (1.1 to 4.9) 0.98
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Figure 4 .

Figure 4

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Mean distal peristaltic duration (DED) at baseline and after edrophonium in patients who reported pain, compared with patients who did not report pain. 


Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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