Follow-up of patients with noncardiac chest pain
- 21 Downloads
- 9 Citations
Abstract
Noncardiac chest pain may be a debilitating symptom. The utility of esophageal testing to enhance patient quality of life has been inconclusive. The purpose of this study was to evaluate prospectively the impact of esophageal testing on patient well-being. Fifty-five patients undergoing esophageal testing were available for follow-up. Seventeen (31%) patients were classified in group 1: considered to have the esophagus as a likely etiology because of positive testing; 14 (25%) in group 2: possible contribution of the esophagus to symptoms; and 24 (44%) in group 3: unlikely esophageal etiology with negative testing. Thirty-four patients continued to be symptomatic at follow-up (median 112 days). The change in pain intensity from pretesting to follow-up was significant only for group 3 (P=0.001). There was a decline in hospital utilization in all three groups. (Emergency room visitsP=0.004 group 1, hospital admissionsP=0.02, group 3). Group 1 and 2 patients tended to miss less work, social functions, and activities. Group 3 continued to stay in bed and avoid normal functions. Nine of 34 (26%) patients who were symptomatic at follow-up identified the esophagus as the source of symptoms. In all, 42% of group 1, 29% of group 2, and 18% of group 3 patients considered the esophagus to be the source of their symptoms. We conclude that esophageal testing does not always prevent the persistence of symptoms and that patients have misperceptions about testing results on follow-up.
Key words
noncardiac chest pain esophageal motility hospital utilization quality of lifePreview
Unable to display preview. Download preview PDF.
References
- 1.Lee MG, Sullivan SN, Watson WC, Melendez LJ: Chest pain-esophageal, cardiac or both? Am J Gastroenterol 80:320–324, 1985PubMedGoogle Scholar
- 2.Ockene IS, Shay MJ, Alpert JS, Weiner BH, Dalen JE: Unexplained chest pain in patients with normal coronary arteriograms. A follow-up study of functional status. N Engl J Med 303:1249–1252, 1980PubMedGoogle Scholar
- 3.Ward BW, Wu WC, Richter JE, Hackshaw BT, Castell DO: Long-term follow-up of symptomatic status of patients with noncardiac chest pain: Is diagnosis of esophageal etiology helpful? Am J Gastroenterol 82:215–218, 1987PubMedGoogle Scholar
- 4.Lee CA, Reynolds JC, Ouyang A, Baker L, Cohen S: Esophageal chest pain, value of high-dose provocative testing with edrophonium chloride in patients with normal esophageal manometries. Dig Dis Sci 32:682–688, 1987PubMedGoogle Scholar
- 5.Burns T, Kellum WC, Bienvenu L, Marcotte R: Esophageal motor disorders and atypical chest pain: Long term clinical follow-up. Am J Gastroenterol 80:833, 1985 (abstract)Google Scholar
- 6.Bemiller CR, Pepine CJ, Rogers AK: Long-term observations in patients with angina and normal coronary arteriograms. Circulation 47:36–43, 1973PubMedGoogle Scholar
- 7.Day LJ, Sowton E: Clinical features and follow-up of patients with angina and normal coronary arteries. Lancet 2:334–337, 1976PubMedGoogle Scholar
- 8.Isner JM, Salem DN, Banas JS, Levine HJ: Long-term clinical course of patients with normal coronary arteriography: Follow-up study of 121 patients with normal or nearly normal coronary anteriograms. Am Heart J 102:645–653, 1981PubMedGoogle Scholar
- 9.Lavey EB, Winkle RA: Continuing disability of patients with chest pain and normal coronary arteriograms. J Chron Dis 32:191–196, 1979PubMedGoogle Scholar
- 10.Lantinga L, Sprafkin RP, McCroskery JH, Baker MT, Warner RA, Hill BE: One-year psychosocial follow-up of patients with chest pain and angiographically normal coronary arteries. Am J Cardiol 62:209–213, 1988PubMedGoogle Scholar