The Edrophonium Response: Use in Diagnosis and Possible Understanding of Mechanisms of Esophageal Chest Pain
A frustrating problem in evaluating patients with suspected esophageal chest pain has been a general inability to clearly implicate the esophagus. Most patients report they have intermittent episodes of chest pain and are rarely obliging enough to experience the pain during the manometric study. A definite statement can only be made when the patient has a typical attack of chest pain during the manometric examination. If a characteristic pattern appears (i.e., diffuse spasm) or the intensity of the pain can be predicted from the manometric recording (i.e., excessive high amplitude peristalsis), then a clear-cut case can be made for an esophageal origin of the chest pain especially if coronary artery disease has been excluded. Unfortunately, in our experiences and others, spontaneous pain with manometric correlation occurs in less than 20% of patients studied. Therefore, a variety of techniques have been suggested to provide an esophageal “stress test.” These have included ice water swallows (1), intraesophageal acid perfusion (2), and injections of bethanechol (3), edrophonium (4), pentagastrin (5), and ergonovine (6). Recent studies from our laboratory have suggested that edrophonium is the best tolerated and most effective provocative test for esophageal chest pains (7). These findings are supported by another study in which patients responding to ergonovine with chest pain and manometry abnormalities were generally found to have a similar response with edrophonium (4).
KeywordsChest Pain Gastrointestinal Motility Esophageal Motility Diffuse Esophageal Spasm Esophageal Contraction
Unable to display preview. Download preview PDF.
- 3.Mellow M. Symptomatic diffuse esophageal spasm: manometric follow-up and response to cholinergic stimulation and cholinesterase inhibition. Gastroenterology 1981; 81: 10–14.Google Scholar
- 7.Benjamin SB, Richter JE, Cordova CM, Knuff TE, Castell DO. Prospective manometric evaluation with pharmacologic provocation of patients with suspected esophageal motility dysfunction. Gastroenterology 1981; 84: 893–901.Google Scholar
- 8.Richter JE, Blackwell JN, Wu WC, Cowan RJ, Johns DN, Castell DO. Assessment of liquid bolus transit by simultaneous radionuclide transit and esophageal manometry. Gastroenterology 1983; 84: 128.Google Scholar