| Popis: |
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). |
