Chest Pain With Normal Coronary Arteriograms: Oesophageal Abnormalities — The Gastroenterologist’s View

  • John S. de Caestecker
Part of the Developments in Cardiovascular Medicine book series (DICM, volume 152)

Abstract

Central chest pain, particularly if precipitated by exertion, implies the likelihood of coronary artery disease to both patient and physician. William Heberden, who introduced the term “angina pectoris” with a full and accurate account of the condition in 1772, failed himself to connect angina with the heart1. Originally, angina was a descriptive term derived from the Greek word ανχηoνε for an inflammatory neck condition2 to convey a sense of the strangling quality of the symptom. With the recognition of coronary artery disease in this century, angina pectoris and heart disease have become synonymous, to the extent that one eminent cardiologist has suggested that angina “is, by definition, associated with a disturbance of myocardial function”3. However, the possibility that oesophageal disease might give rise to similar symptoms was apparent even in Heberden’s description of angina, as he observed that the symptom could occur during swallowing or after a meal. Indeed, he speculated (perhaps prophetically when seen from the viewpoint of a gastroenterologist) that the source of angina “may be a strong cramp, or an ulcer, or both”1.

Keywords

Placebo Catheter Glycerine Depression Ischemia 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Heberden, W: Some account of a disorder of the breast. Med Trans Coll Phys Lond 1772; 2: 59 – 67Google Scholar
  2. 2.
    Frank, PI: Some historical aspects of chest pain. Practitioner 1973; 211: 96 -104PubMedGoogle Scholar
  3. 3.
    Julia, DG: The definition of angina. Eur Heart J 1980; 1: 100Google Scholar
  4. 4.
    White, P: The differential diagnosis of gastrointestinal and cardiac disorders. Am J Dig Dis Nutr 1937; 4: 650 – 657CrossRefGoogle Scholar
  5. 5.
    Verdon, W: Angina pectoris. Published - Moulton, Brighton, 1920Google Scholar
  6. 6.
    Jackson, DE., Jackson, HL: Experimental and clinical observations regarding angina pectoris and some related symptoms. J Lab Clin Med 1936; 21: 993 -1006Google Scholar
  7. 7.
    Morrison, LM., Swalm, WA: Role of the gastrointestinal tract in production of cardiac symptoms: experimental and clinical observations. J Am Med Assoc 1940; 114: 217 – 223CrossRefGoogle Scholar
  8. 8.
    Kramer, P., Hollander, W: Comparison of experimental oesophageal pain with clinical pain of angina pectoris and oesophageal disease. Gastroenterology 1955; 29: 719 – 743PubMedGoogle Scholar
  9. 9.
    Dart, AM, Alban-Davies, H., Griffith, T., Henderson, AH: Does it help to undiagnose angina? Eur Heart J 1983; 4: 461 – 462PubMedGoogle Scholar
  10. 10.
    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 Eng J Med 1980; 303: 1249 – 1252CrossRefGoogle Scholar
  11. 11.
    Castell, DO: Chest pain of undetermined origin: overview of pathophysiology. Am J Med 1992; 92 (Suppl 5A): 2S – 4SCrossRefGoogle Scholar
  12. 12.
    Mei, N: La sensibilité viscerale. J Physiol (Paris) 1981; 77: 597 – 612Google Scholar
  13. 13.
    Cervero, F: Neurophysiology of gastrointestinal pain. Balliere’s Clin Gastroenterol 1988; 2: 183 -199CrossRefGoogle Scholar
  14. 14.
    Rodrigo, J., Hernandez, CJ., Vidal, MA., Pedrosa, JA: Vegetative innervation of the oesophagus. II: Intra-ganglionic laminar endings. Acta Anat 1975; 92: 79 -100PubMedCrossRefGoogle Scholar
  15. 15.
    Rodrigo, J., Nava, BE., Pedrosa, J: Study of vegetative innervation of the oesophagus. I. Perivascular endings. Trab del Inst Cajal (Invest Biol) 1970; 62: 39–65Google Scholar
  16. 16.
    Christensen, J., Robison, BA: Anatomy of the myenteric plexus of the opossum oesophagus. Gastroenterology 1982; 83:1033 -1042PubMedGoogle Scholar
  17. 17.
    Hertz, AF: The sensibility of the alimentary canal in health and disease: lecture I. Lancet 1911; i: 1051–1056Google Scholar
  18. 18.
    Jones, CM., Chapman. WP: Studies on the mechanism of the pain of angina pectoris with particular relation to hiatus hernia. Trans Assoc Amer Phys 1942; 57: 139 -151Google Scholar
  19. 19.
    Williams, AF: Oesophageal sensation after sympathectomy. Thorax 1950; 5: 40–42CrossRefGoogle Scholar
  20. 20.
    Sengupta, JN., Kauvar, D., Goyal, RK: Characteristics of vagal oesophageal tension-sensitive afferent fibres in the opossum. J Neuro Physiol 1989; 61: 1001 -1010Google Scholar
  21. 21.
    Sengupta, JN., Saha JK., Goyal, RK: Stimulus-response function studies of oesophageal mechanosensitive nociceptors in sympathetic afferents of opossum. J Neuro Physiol 1990; 64: 796 – 812Google Scholar
  22. 22.
    Foreman, RD: Viscerosomatic convergence onto spinal neurones responding to afferent fibres located in the inferior cardiac nerve. Brain Res 1977; 137: 164 -168PubMedCrossRefGoogle Scholar
  23. 23.
    Foreman, RD., Hancock, MB., Willis, WD: Responses of spinothalamic tract cells in the thoracic spinal cord of the monkey to cutaneous and visceral inputs. Pain 1981; 11: 149–162PubMedCrossRefGoogle Scholar
  24. 24.
    Blair, RW., Weber, RN., Foreman, RD: Characteristics of primate spinothalamic tract neurones receiving viscerosomatic convergent inputs in T3 – T5 segments. J Neurophysiol 1981; 46: 797 – 811PubMedGoogle Scholar
  25. 25.
    Cervero, F: Mechanisms of acute visceral pain. Br Med Bull 1991; 47: 549 -560PubMedGoogle Scholar
  26. 26.
    Foreman, RD., Ohata, CA: Effects of coronary artery occlusion on thoracic spinal neurones receiving viscerosomatic inputs. Am J Physiol 1980; 238: H667 – H674Google Scholar
  27. 27.
    Foreman, RD., Ammon, WS: Angina-like pain: spinal mechanism underlying this symptom in gallbladder disease. In: Advances in pain research and therapy. Ed. Fields HL (Raven Press, New York 1985); 9 : 177 -184Google Scholar
  28. 28.
    Witt, I., Griffin, JP: Afferent cutaneous C-fîbre reactivity to repeated thermal stimuli. Nature 1962; 194: 776 – 777PubMedCrossRefGoogle Scholar
  29. 29.
    Bessou, P., Perl, ER: Response of cutaneous sensory units with unmyelinated fibres to noxious stimuli. J Neurophysiol 1969; 32: 1025 -1243PubMedGoogle Scholar
  30. 30.
    Bietel, RE., Dubner, R: Response of unmyelinated (C) polymodal nociceptors to thermal stimuli applied to monkey’ s face. J Neurophysiol 1976; 39: 1160 -1175Google Scholar
  31. 31.
    Kumazawa, T., Mizumura, K: Mechanical and thermal responses of polymodal receptors recorded from the superior spermatic nerve of dogs. J Physiol 1987; 299: 233 – 245Google Scholar
  32. 32.
    Haupt, P, Janig, W., Kohler, W: Response pattern of visceral afferent fibres, supplying the colon, upon chemical and mechanical stimuli. Pflugers Arch 1983; 398: 41 – 47PubMedCrossRefGoogle Scholar
  33. 33.
    Cervero, F., Sann, H: Mechanically evoked responses of afferent fibres innervating the guinea pig’ s ureter: an in vitro study. J Physiol 1989; 412: 245 – 266PubMedGoogle Scholar
  34. 34.
    Mehta, A., de Caestecker, JS., Northfield, TC: Evidence for pre-sensitisation of oesophageal nociceptors in patients with oesophageal chest pain. Gastroenterology 1992; 102: A483Google Scholar
  35. 35.
    Richter, JE., Barish, CF., Castell, DO: Abnormal sensory perception in patients with oesophageal chest pain. Gastroenterology 1986; 91: 845 – 852PubMedGoogle Scholar
  36. 36.
    Melzack, R., Wall, PD: Pain mechanisms: a new theory. Science 1965; 150: 971 – 979PubMedCrossRefGoogle Scholar
  37. 37.
    Melzack, R: Recent concepts of pain. J Med 1982; 13: 147 -160PubMedGoogle Scholar
  38. 38.
    Besson, JM., Guilbaud, G., Abdelmoumene, M., Chaouch, A: Physiologie de la nociception. J Physiol (Paris) 1982; 78: 7 – 107Google Scholar
  39. 39.
    Jessell, TM: Pain. Lancet 1982; ii: 1084 – 1088CrossRefGoogle Scholar
  40. 40.
    Tibbling, L: Oesophageal dysfunction and angina pectoris in a Swedish population selected at random. Acta Med Scand 1981; 644 (Suppl): 71–74Google Scholar
  41. 41.
    Bennett, JR., Atkinson, M: The differentiation between oesophageal and cardiac pain. Lancet 1966; ii: 1123 – 1127CrossRefGoogle Scholar
  42. 42.
    Alban-Davies, H., Jones, DB., Rhodes, J: “ Oesophageal angina” as the cause of chest pain. J A M A 1982; 248: 2274 – 2278CrossRefGoogle Scholar
  43. 43.
    Pasternak, RC., Thibault, GE., Savoia, M., De Sanctis, RW., Hutter, AM: Chest pain with angiographically insignificant coronary arterial obstruction: clinical presentation and long-term follow-up. Am J Med 1980; 68: 813 – 817PubMedCrossRefGoogle Scholar
  44. 44.
    Day, LJ., Sowton, E: Clinical features and follow-up of patients with angina and normal coronary arteries. Lancet 1976; ii: 334 – 337CrossRefGoogle Scholar
  45. 45.
    Dart, AM., Alban-Davies, H., Dalai, J., Ruttley. M., Henderson, AH: “ Angina” and normal coronary arteriograms: a follow-up study. Eur Heart J 1980; 1: 97 -100PubMedGoogle Scholar
  46. 46.
    Marchandise, B., Bourassa, MG., Chaitman, BR., Lesperance, J: Angiographic evaluation of the natural history of normal coronary arteries and mild coronary atherosclerosis. Am J Cardiol 1978; 41: 216 – 220PubMedCrossRefGoogle Scholar
  47. 47.
    Proudfit, WL., Shirey, EK., Sones, FM: Selective cine coronary arteriography: correlation with clinical findings in 1,000 patients. Circulation 1966; 33: 901–910PubMedCrossRefGoogle Scholar
  48. 48.
    Castell, DO: Oesophageal chest pain. Am J Gastroenterol 1984; 79: 969 – 971PubMedGoogle Scholar
  49. 49.
    Hamberg, J., Lindahl. O: Angina pectoris caused by thoracic spine disorders: clinical examination and treatment. Acta Med Scand 1981;644 (Suppl): 84 – 86Google Scholar
  50. 50.
    Brand, DL: Chest pain of oesophageal origin. In: Diseases of the oesophagus. Eds. Cohen S, Soloway RD. (Churchill Livingstone, 1982) p 137 – 159Google Scholar
  51. 51.
    Urschel, HC., Razzuk, MA., Hyland, JW et al: Thoracic outlet syndrome masquerading as coronary artery disease (pseudoangina). Ann Thorac Surg 1973; 16: 239 – 248PubMedCrossRefGoogle Scholar
  52. 52.
    Lewis, T: Pain. The Macmillan Co, New York 1942Google Scholar
  53. 53.
    Channer, KS., Papouchado, M., James, MA., Rees, JR: Anxiety and depression in patients with chest pain referred for exercise testing. Lancet 1985; ii: 820 – 822CrossRefGoogle Scholar
  54. 54.
    Bass, C., Wade, C: Chest pain with normal coronary arteries: a comparative study of psychiatric and social morbidity. Psychol Med 1984; 14: 51 – 61PubMedCrossRefGoogle Scholar
  55. 55.
    Bass, C., Cawley, R., Wade, C et al: Unexplained breathlessness and psychiatric morbidity in patients with normal and abnormal coronary arteries. Lancet 1983; i: 605 – 609CrossRefGoogle Scholar
  56. 56.
    Wood, P: Da Costa’ s syndrome (or effort syndrome). Br Med J 1941; i: 767–772CrossRefGoogle Scholar
  57. 57.
    Valori, RM., Cole, E., Lemon, M., Howard R., Cockel, R: Hyperventilation increases the amplitude of oesophageal contractions in healthy volunteers: a controlled study. Gut 1988; 29: A1447Google Scholar
  58. 58.
    Rubin, J., Nagler, R., Spiro, HM., Pilot, ML: Measuring the effect of emotions on oesophageal motility. Psychosom Med 1962; 24: 170 – 176PubMedGoogle Scholar
  59. 59.
    Anderson, KO., Dalton, CB., Bradley, LA., Richter, JE: Stress induces alteration of oesophageal pressures in healthy volunteers and non-cardiac chest pain patients. Dig Dis Sci 1989; 34: 83 – 91PubMedCrossRefGoogle Scholar
  60. 60.
    Ayres, RCS., Robertson, DA., Naylor, K., Smith, CL: Stress and oesophageal motility in normal subjects and patients with irritable bowel syndrome. Gut 1989; 30: 1540 -1543PubMedCrossRefGoogle Scholar
  61. 61.
    Richter, JE., Obrecht, F., Bradley, LA., Young, LD., Anderson, KO: Psychological comparison of patients with nutcracker oesophagus and irritable bowel syndrome. Dig Dis Sci 1986; 31: 131 – 138PubMedCrossRefGoogle Scholar
  62. 62.
    Clouse, RE., Ekert, TC: Gastrointestinal symptoms of patients with oesophageal contraction abnormalities. Dig Dis Sci 1986; 31: 236 – 240PubMedCrossRefGoogle Scholar
  63. 63.
    Stark, GA., McMahon, TP., Richter, JE: Increasing evidence for the irritable gut syndrome. Gastroenterology 1987; 92: 1652Google Scholar
  64. 64.
    Whitehead, WE., Bosmajian, L,. Zonderman, AB., Costa, PT., Schuster, MM: Syndrome of psychologic distress associated with irritable bowel syndrome: comparison of community and medical clinic samples. Gastroenterology 1988; 95: 709 – 714PubMedGoogle Scholar
  65. 65.
    Long, WB., Cohen, S: The digestive tract as a cause of chest pain. Am Heart J 1980; 100: 567 – 572PubMedCrossRefGoogle Scholar
  66. 66.
    Ravdin, IS., Fitz-Hugh, T., Wolferth, CC., Barbier, EA., Ravdin, RG: Relation of gallstone disease to angina pectoris. Arch Surg 1955; 115: 1055 -1062Google Scholar
  67. 67.
    Hampton, AG,, Beckwith, JR., Wood, JE: The relationship between heart disease and gallbladder disease. Ann Intern Med 1959; 50:1135 -1148PubMedGoogle Scholar
  68. 68.
    Dworken, HJ., Biel, FJ., Machella, TE: Supradiaphragmatic reference of pain from the colon. Gastroenterology 1952; 22: 222 – 231PubMedGoogle Scholar
  69. 69.
    Bennett, JR: Chest pain: heart or gullet? Br Med J 1983; 286: 1231 – 1232CrossRefGoogle Scholar
  70. 70.
    de Caestecker, JS., Blackwell, JN., Brown, J., Heading, RC: The oesophagus as a cause of recurrent chest pain: which patients should be investigated and which tests used? Lancet 1985; ii: 1143 – 1146CrossRefGoogle Scholar
  71. 71.
    Ghillebert, G., Janssens, J., Vantrappen, G., Nevens, F., Piessen, J: Ambulatory 24-hour intra-oesophageal pH and pressure recordings v. provocation tests in the diagnosis of chest pain of oesophageal origin. Gut 1990; 31: 738 – 744PubMedCrossRefGoogle Scholar
  72. 72.
    Svensson, O., Stenport, G., Tibbling, L., Wranne, B: Oesophageal function and coronary angiograms in patients with disabling chest pain. Acta Med Scand 1978; 204: 173 – 178PubMedCrossRefGoogle Scholar
  73. 73.
    Areskog, M: Oesophageal dysfunction and ischaemic heart disease as origin of chest pain in non-infarction coronary care unit patients and patients with myocardial infarction. Acta Med Scand 1981; 644 (Suppl): 69 – 70Google Scholar
  74. 74.
    Ducrotte, P., Berland, J., Denis, P et al: Coronary sinus lactate estimation and oesophageal motor anomalies in angina with normal coronary angiogram. Dig Dis Sci 1984; 29: 305 – 310PubMedCrossRefGoogle Scholar
  75. 75.
    Stentoft, P., Aggestrup, S., Mortensen, SA: Oesophageal pH and pressure measurements in patients with coronary artery disease. In: Oesophagus 88: the present status of diagnosis and treatment of oesophageal disease. Boesby S, Svensen HR, eds. Danish Gut Club, Copenhagen, Denmark 1988: p 200 – 203Google Scholar
  76. 76.
    de Caestecker, JS., Pryde, A., Heading, RC: Oesophageal abnormalities in patients with symptomatic coronary artery disease. Gullet 1992; 2: 74 – 76Google Scholar
  77. 77.
    Schofield, PM., Whorwell, PJ., Brooks, NH., Bennett, DH., Jones, PE: Oesophageal function in patients with angina pectoris: a comparison of patients with normal coronary angiograms and patients with coronary artery disease. Digestion 1989; 42: 70 – 78PubMedCrossRefGoogle Scholar
  78. 78.
    Brand, DL., Martin, D., Pope, CE: Oesophageal manometrics in patients with angina-like chest pain. Dig Dis 1977; 22: 300 – 304CrossRefGoogle Scholar
  79. 79.
    Peters, L., Maas, L., Petty, D et al: Spontaneous non-cardiac chest pain: evaluation by 24-hour ambulatory oesophageal motility and pH monitoring. Gastroenterology 1988; 94: 878 – 886PubMedGoogle Scholar
  80. 80.
    Breumelhof, R., Nadorp, JHSM, Akkermans LMA, Smout AJPM: Analysis of 24-hour oesophageal pressure and pH data in unselected patients with noncardiac chest pain. Gastroenterology 1990; 99: 1257 – 1264PubMedGoogle Scholar
  81. 81.
    Richter, JE., Hackshaw, BT., Wu, WC., Castell, DO: Edrophonium: a useful provocative test for oesophageal chest pain. Ann. Intern Med 1985; 103: 14 -21PubMedGoogle Scholar
  82. 82.
    Bennett, JR., Atkinson, M: Oesophageal acid-perfusion in the diagnosis of precordial pain. Lancet 1966; ii: 1150 -1152CrossRefGoogle Scholar
  83. 83.
    Barish, CF., Castell, DO., Richter, JE: Graded oesophageal balloon distension: a new provocative test for non-cardiac chest pain. Dig Dis Sci 1986; 31: 1292 -1298PubMedCrossRefGoogle Scholar
  84. 84.
    Demeester, TR., O’ Sullivan, GC., Bermudez, G et al: Oesophageal function in patients with angina-type chest pain and normal coronary angiograms. Ann Surg 1982; 196: 488 – 498PubMedCrossRefGoogle Scholar
  85. 85.
    Katz, PO., Dalton, CB., Richter, JE., Wu, WC., Castell, DO: ‘Oesophageal testing of patients with non-cardiac chest pain or dysphagia: results of three years’ experience with 1161 patients. Ann Intern Med 1987; 106: 593 – 597PubMedGoogle Scholar
  86. 86.
    De Vault, KR., Castell, DO: Oesophageal balloon distension and cerebral evoked potential recording in the evaluation of unexplained chest pain. Am J Med 1992; 92 (Suppl 5A): 20S – 26SCrossRefGoogle Scholar
  87. 87.
    Mackenzie, J., Belch, J., Land, D., Park, R., McKillop, J: Oesophageal ischaemia in motility disorders associated with chest pain. Lancet 1988; ii: 592 – 595CrossRefGoogle Scholar
  88. 88.
    Clouse, RE., Staiano, A., Landau, DW., Schlachter, JL: Manometric findings during spontaneous chest pain in patients with presumed oesophageal “ spasms” . Gastroenterology 1983; 85: 395 – 402PubMedGoogle Scholar
  89. 89.
    Rosen, AM., Maher, KA., Cattau, EL., Benjamin, S: Oesophageal ischaemia: does it play a role in non-cardiac chest pain? Gastroenterology 1989; 96: A425Google Scholar
  90. 90.
    Alban-Davies, H., Jones, DB., Rhodes, J., Newcombe, RG: Angina-like oesophageal pain: differentiation from cardiac pain by history. J Clin Gastroenterol 1985; 7: 477 – 481CrossRefGoogle Scholar
  91. 91.
    Schofield, PM., Bennett, DH., Whorwell, PJ et al: Exertional gastro-oesophageal reflux: a mechanism for symptoms in patients with angina pectoris and normal coronary angiograms. Br Med J 1987; 294:1459 – 1461CrossRefGoogle Scholar
  92. 92.
    Hewson, EG., Dalton, CB., Richter, JE: Comparison of oesophageal manometry, provocation testing and ambulatory monitoring in patients with unexplained chest pain. Dig Dis Sci 1990; 35: 302 – 309PubMedCrossRefGoogle Scholar
  93. 93.
    Dyer, NH., Pridie, RB: Incidence of hiatus hernia in asymptomatic subjects. Gut 1968; 9: 696 – 699PubMedCrossRefGoogle Scholar
  94. 94.
    Sellar, RJ., de Caestecker, JS., Heading, RC: Barium radiology: a sensitive test for gastro-oesophageal reflux. Clin. Radiol 1987; 38: 303 – 307PubMedCrossRefGoogle Scholar
  95. 95.
    Bernstein, LM., Baker, LA: A clinical test for oesophagitis. Gastroenterology 1958; 34: 760 – 781PubMedGoogle Scholar
  96. 96.
    Bernstein, LM., Fruin, RC., Pacini, R: Differentiation of oesophageal pain from angina pectoris: role of the oesophageal acid perfusion test. Medicine (Balt) 1962; 41: 143 – 162CrossRefGoogle Scholar
  97. 97.
    Vantrappen, G., Janssens, J,. Ghillebert, G: The irritable oesophagus – a frequent cause of angina-like pain. Lancet 1987; i: 1232 – 1234CrossRefGoogle Scholar
  98. 98.
    de Caestecker, JS., Pryde, A., Heading, RC: Comparison of intravenous edrophonium and oesophageal acid perfusion during oesophageal manometry in patients with non-cardiac chest pain. Gut 1988; 29: 1029 -1034PubMedCrossRefGoogle Scholar
  99. 99.
    Hewson, EG., Sinclair, JW., Dalton, CB et al: Acid perfusion test: does it have a role in the assessment of non-cardiac chest pain? Gut 1989; 30: 305 – 310PubMedCrossRefGoogle Scholar
  100. 100.
    de Caestecker, JS., Heading, RC: Acid perfusion in the assessment of non-cardiac chest pain. Gut 1989; 30: 1795 – 1796PubMedCrossRefGoogle Scholar
  101. 101.
    de Caestecker, JS., Heading, RC: Oesophageal pH monitoring. Gastroenterol Clin N A 1990; 19: 645 – 669Google Scholar
  102. 102.
    Schindlbeck, NE., Heinrich, C., Konig, A et al: Optimal thresholds, sensitivity and specificity of long term pH-metry for the detection of gastro-oesophageal reflux disease. Gastroenterology 1987; 93: 85 – 90PubMedGoogle Scholar
  103. 103.
    Weiner, GJ., Richter, JE., Copper, JB., Wu, WC., Castell, DO: The symptom index: a clinically important parameter of ambulatory 24-hour oesophageal pH monitoring. Am J Gastroenterol 1988; 83: 358 – 361Google Scholar
  104. 104.
    Osier, W: Principles and practice of medicine. D Appleton and Co, New York (1892)Google Scholar
  105. 105.
    Moersch, HJ., Camp, JD: Diffuse spasm of the lower part of the oesophagus. Ann Otolaryngol (St. Louis) 1934; 43: 1165 – 1173Google Scholar
  106. 106.
    Dodds, WJ: Instrumentation and methods for intra-luminal oesophageal manometry. Arch Intern Med 1976; 136: 515 – 523PubMedCrossRefGoogle Scholar
  107. 107.
    Richter, JE., Wu, WC., Johns, DN et al: Oesophageal manometry in 95 healthy adult volunteers: variability of pressures with age and frequency of “ abnormal” contractions. Dig Dis Sci 1987; 32: 583 – 592PubMedCrossRefGoogle Scholar
  108. 108.
    Benjamin, SB., Richter, JE., Cordova, CM., Knuff, TE., Castell, DO: Prospective manometric evaluation with pharmacologic provocation of patients with suspected oesophageal motility dysfunction. Gastroenterology 1983; 84: 893 -901PubMedGoogle Scholar
  109. 109.
    Clouse, RE., Staiano, A: Contraction abnormalities of the oesophageal body in patients referred for manometry: a new approach to manometric classification. Dig Dis Sci 1983; 28: 784 – 791PubMedCrossRefGoogle Scholar
  110. 110.
    Benjamin, SB., Gerhardt DC., Castell, DO: High amplitude peristaltic contractions associated with chest pain and/or dysphagia. Gastroenterology 1979; 77: 478 – 483PubMedGoogle Scholar
  111. 111.
    Blackwell, JN., Castell, DO: Oesophageal chest pain: a point of view. Gut 1984; 25: 1 – 6PubMedCrossRefGoogle Scholar
  112. 112.
    Richter, JE., Dalton, CB., Bradley, LA., Castell, DO: Oral nifedipine in the treatment of non-cardiac chest pain in patients with the nutcracker oesophagus. Gastroenterology 1987; 93: 21 – 28PubMedGoogle Scholar
  113. 113.
    Dalton, CB., Castell, DO., Richter, JE: The changing faces of the nutcracker oesophagus. Am J Gastroenterol 1988; 83: 623 – 628PubMedGoogle Scholar
  114. 114.
    Waterman, DC., Dalton, CB., Ott, DJ et al: Hypertensive lower oesophageal sphincter: what does it mean? J Clin Gastroenterol 1989; 11: 139 – 146PubMedCrossRefGoogle Scholar
  115. 115.
    Deschner, WK., Maher, KA., Cattau, EL., Benjamin, SB: Intra-oesophageal balloon distension versus drug provocation in the evaluation of non-cardiac chest pain. Am J Gastrenterol 1990; 85: 938 – 943Google Scholar
  116. 116.
    Smout, AJPM., DeVore, MS., Dalton, CD., Castell, DO: Cerebral potentials evoked by oesophageal distension in patients with non-cardiac chest pain. Gut 1992; 33: 298 – 302PubMedCrossRefGoogle Scholar
  117. 117.
    Kramer, P: Diagnostic value of oesophageal balloon distension. Gastroenterology 1989; 96: 271 – 272PubMedGoogle Scholar
  118. 118.
    Meyer, GW., Castell, DO: Human oesophageal response during chest pain induced by swallowing cold liquids. J A M A 1981; 246: 2057 – 2059PubMedCrossRefGoogle Scholar
  119. 119.
    Nasrallah, SM., Hendrix, EA: Comparison of hypertonic glucose to other provocative tests in patients with non-cardiac chest pain. Am J Gastroenterol 1987; 82: 406 – 409PubMedGoogle Scholar
  120. 120.
    Alban-Davies, H., Kaye, MD., Rhodes, J., Dart, AM., Henderson, AH: Diagnosis of oesophageal spasm by ergometrine provocation. Gut 1982; 23: 89 – 97CrossRefGoogle Scholar
  121. 121.
    Buxton, A., Goldberg, S., Hirschfeld, JW et al: Refractory ergonovine-induced coronary vasospasm: importance of intracoronary nitro-glycerine. Am J Cardiol 1980; 46: 329 – 334PubMedCrossRefGoogle Scholar
  122. 122.
    Lee, CA., Reynolds, JC., Ouyang, A., Baker, L., Cohen, S: Oesophageal chest pain: value of high-dose provocative testing with edrophonium chloride in patients with normal oesophageal manometries. Dig Dis Sci 1987; 32: 682 – 688PubMedCrossRefGoogle Scholar
  123. 123.
    Nostrant, TT., Sams, J., Huber, T.: Bethanecol increases the diagnostic yield in patients with oesophageal chest pain. Gastroenterology 1986; 91: 1141 – 1146PubMedGoogle Scholar
  124. 124.
    de Caestecker, JS., Pryde, A., Heading, RC: Site and mechanism of pain perception with oesophageal balloon distension and intravenous edrophonium in patients with oesophageal chest pain. Gut 1992; 33: 580 – 586PubMedCrossRefGoogle Scholar
  125. 125.
    Janssens, JPF., Vantrappen, G: Irritable oesophagus. Am J Med 1992; 92 (Suppl 5A): 27S – 32SCrossRefGoogle Scholar
  126. 126.
    Smith, KS., Papp, C: Episodic, postural and linked angina. Br Med 1962; J ii: 1425 – 1430CrossRefGoogle Scholar
  127. 127.
    Mellow, MH., Simpson, AG., Watt, L., Schoolmeester, L., Haye, OL: Oesophageal acid perfusion in coronary artery disease: induction of myocardial ischaemia. Gastroenterology 1983; 85: 306 – 312PubMedGoogle Scholar
  128. 128.
    Alban-Davies, H., Page, Z., Rush, EM et al: Oesophageal stimulation lowers exertional angina threshold. Lancet 1985; i: 1011 – 1014CrossRefGoogle Scholar
  129. 129.
    Serebro, HA: The prognostic significance of the viscerocardiac reflex phenomenon. S Afr Med 1976; J 50: 769 – 772Google Scholar
  130. 130.
    Garcia, PJ., Pate,l PH., Hunter, WC., Douglas, JE., Thomas, E: Oesophageal contribution to chest pain in patients with coronary artery disease. Chest 1990; 98: 806 – 810CrossRefGoogle Scholar
  131. 131.
    Singh, S., Richter, JE., Hewson, EG., Sinclair, JW., Hackshaw, BT: The contribution of gastro-oesophageal reflux to chest pain in patients with coronary artery disease. Ann Int Med 1992; 117: 824 – 830PubMedGoogle Scholar
  132. 132.
    Mehta, AJ., de Caestecker, JS., Northfield, TC: Gastro-oesophageal reflux in patients with coronary artery disease: how common is it and does it matter? Gastroenterology 1993; (In Press)Google Scholar
  133. 133.
    Spears, PF., Koch, KL: Oesophageal disorders in patients with chest pain and mitral valve prolapse. Am J Gastroenterol 1986; 81: 951 – 954PubMedGoogle Scholar
  134. 134.
    Schofield, PM., Brooks, NH., Colgan, S et al: Left ventricular function and oesophageal function in patients with angina pectoris and normal coronary angiograms. Br Heart J 1987; 58: 218 – 224PubMedCrossRefGoogle Scholar
  135. 135.
    Cannon, RO., Cattau, EL., Yakshe, PN et al: Coronary flow reserve, oesophageal motility, and chest pain in patients with angiographically normal coronary arteries. Am J Med 1990; 88: 217 – 222PubMedCrossRefGoogle Scholar
  136. 136.
    Lee, MG., Sullivan, SN., Watson, WC., Melendez, LJ: Chest pain - oesophageal, cardiac or both? Am J Gastroenterol 1985: 80: 320 – 324PubMedGoogle Scholar
  137. 137.
    Rasmussen, K., Ravnsbaek, J., Funch-Jensen, P., Bagger, JP: Oesophageal spasm in patients with coronary artery spasm. Lancet 1986; i: 174 – 176CrossRefGoogle Scholar
  138. 138.
    Yackee, J., Lipson, A., Wasserman, AG: Electrocardiographic changes suggestive of cardiac ischemia in a patients with oesophageal food impaction: “ a case that’ s hard to swallow” . J A M A 1986; 255: 2065 – 2066PubMedCrossRefGoogle Scholar
  139. 139.
    Shapiro, LM., Crake, T., Poole-Wilson, PA: Is altered cardiac sensation responsible for chest pain in patients with normal coronary arteries? Clinical observation during catheterisation. Br Med J 1988; 296: 170 -171CrossRefGoogle Scholar
  140. 140.
    Cannon, RO., Quyyumi, AA., Schenke, WH et al: Abnormal cardiac sensitivity in patients with chest pain and normal coronary arteries. J Am Coll Cardiol 1990; 16: 1359 – 1366PubMedCrossRefGoogle Scholar
  141. 141.
    Lavey, EB., Winkle, RA: Continuing disability of patients with chest pain and normal coronary arteriograms. J Chron Dis 1978; 32: 191 – 196CrossRefGoogle Scholar
  142. 142.
    Browning, TH and members of the Patient Care Committee of the American Gastroenterological Association: Diagnosis of chest pain of oesophageal origin. Dis Dig Sci 1990; 35: 289 – 293CrossRefGoogle Scholar
  143. 143.
    Ward, BW., Wu. WC., Richter JE, Hackshaw BT, Castell DO: Long term followup of symptomatic status of patients with non-cardiac chest pain: is diagnosis of oesophageal aetiology helpful? Am J Gastoenterol 1987; 82: 215 – 218Google Scholar
  144. 144.
    de Caestecker, JS., Bruce, GM., Heading, RC: Follow-up of patients with chest pain and normal coronary arteriography: the impact of oesophageal investigations. Eur J Gastroenterol Hepatol 1991; 3: 899 – 905Google Scholar
  145. 145.
    Alban-Davies, HA., Lewis, MJ., Rhodes, J., Henderson, AH: Trial of nifedipine for prevention of oesophageal spasm. Digestion 1987; 36: 81 – 83CrossRefGoogle Scholar
  146. 146.
    Swamy, N: Oesophageal spasm: clinical and manometric response to nitroglycerine and long acting nitrites. Gastroenterology 1977; 72: 23 – 27PubMedGoogle Scholar
  147. 147.
    Nasrallah, SM: Nifedipine in the treatment of diffuse oesophageal spasm. Lancet 1982; ii: 1285 – 1286CrossRefGoogle Scholar
  148. 148.
    Clouse, RE., Lustman, PJ., Eckert, TC., Ferney, DM., Griffith, LS: Low dose trazodone for symptomatic patients with oesophageal contraction abnormalities: a double-blind, placebo-controlled trial. Gastroenterology 1987; 92: 1027 -1036PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1994

Authors and Affiliations

  • John S. de Caestecker
    • 1
  1. 1.Glenfield General HospitalLeicesterUK

Personalised recommendations