scholarly journals Esophageal Manometry with Provocative Testing in Patients with Noncardiac Angina-Like Chest Pain

1991 ◽  
Vol 5 (2) ◽  
pp. 51-57 ◽  
Author(s):  
William G Paterson ◽  
Delia A Marciano-D’Amore ◽  
Ivan T Beck ◽  
Laurington R Da Costa
Keyword(s):  
Chest Pain ◽  
Esophageal Motility ◽  
Esophageal Manometry ◽  
Motility Disorder ◽  
Diffuse Esophageal Spasm ◽  
Esophageal Motility Disorder ◽  
Nutcracker Esophagus ◽  
Hypertensive Lower Esophageal Sphincter ◽  
Acid Perfusion ◽  
Provocative Testing

In a five year period 238 of 594 esophageal manometric studies performed in the authors’ laboratory were done on patients whose major reason for referral was noncardiac angina-like chest pain. Standard eophageal manometry was performed followed by an acid-antacid perfusion period (Bernstein test) and then subcutaneous bethanechol (80 μg/kg to a maximum of 5 mg) was adminstered. Baseline manometry was normal in 38% of patients and was diagnostic of ‘nutcracker’ esophagus, nonspecific esophageal motility disorder, diffuse esophageal spasm and isolated hypertensive lower esophageal sphincter in 24%, 19%, 16% and 3% of patients, respectively. Ninety-six of 238 patients (40%) experienced reproduction of their presenting angina-like chest pain during acid perfusion. In 80% of these patients there were associated esophageal motor abnormal ilies induced by the acid perfusion. Thirty-six of 212 (17%) experienced pain reproduction following the injection of bethanechol; however, 16 of these had already had their presenting chest pain reproduced during the acid perfusion study. In two-thirds of the patients with pain reproduction following bechanechol there was an associated bethanechol-induced esophageal motility disorder. Overall 49% of patients had their pain reproduced during provocative testing. The acid perfusion test reproduced the pain much more frequently than bethanechol simulation. This study reaffirms the value of esophageal manometry and provocative testing in this group of patients.

scholarly journals Spectrum of Esophageal Motility Disorders in Patients with Motor Dysphagia and Noncardiac Chest Pain ‑ A Single Center Experience

2017 ◽  
Vol 08 (02) ◽  
pp. 068-071
Author(s):  
Rinkesh Kumar Bansal ◽  
Mukesh Nasa ◽  
Gaurav Kumar Patil ◽  
Vinit Shah ◽  
Narendra S. Choudhary ◽  
...  
Keyword(s):  
Chest Pain ◽  
High Resolution ◽  
Esophageal Motility ◽  
Esophageal Manometry ◽  
Motility Disorder ◽  
Esophageal Motility Disorders ◽  
Noncardiac Chest Pain ◽  
Esophageal Motility Disorder ◽  
Motility Disorders ◽  
High Resolution Manometry

ABSTRACT Aims and Objective: High‑resolution esophageal manometry is the most important investigation for the evaluation of patients with dysphagia and noncardiac chest pain (NCCP). Chicago Classification (CC) utilizing an algorithmic approach in analyzing high‑resolution manometry has been accepted worldwide, and an updated version, CC v3.0, of this classification has been developed by the International high‑resolution manometry working Group in 2014. Data on the spectrum of esophageal motility disorders in Indian population are scarce as well as a newer version of CC has not been used to classify. The aim of our study is to evaluate clinical presentation and manometric profile of patients with suspected esophageal motility disorders using CC v3.0. Methodology: In this retrospective study, consecutive patients referred for esophageal manometry at our center from 2010 to 2015 were included in the study. High‑resolution esophageal manometry was performed with 22‑channel water‑perfusion system (MMS, The Netherlands). Newer version of CC (CC v3.0) was used to classify motility disorders. Results: A total of 400 patients were included, with a mean age of 44 years and 67.5% were males. Out of these, 60% (n = 240) patients presented with motor dysphagia while 40% (n = 160) had NCCP. Motility disorder was present in 50.5% (n = 202) of the patients while 49.5% (n = 198) patients had normal manometry. Disorders of esophagogastric junction outflow were the predominant type of disorder, found in 33.75% (n = 135). About 14.25% (n = 57) of the patients had minor disorders of peristalsis while 5% (n = 20) of the patients had other major disorders of peristalsis. Achalasia was the most common motility disorder present in 30% (n = 120) patients. Conclusion: Dysphagia was the most common esophageal symptom followed by NCCP in our series. Achalasia was the most common esophageal motility disorder followed by fragmented peristalsis.

Spastic Motility Disorders: Diagnosis and Management in the Era of the Chicago Classification

2021 ◽  
Vol 1 (3) ◽  
pp. 254-262
Author(s):  
Mario Costantini ◽  
Renato Salvador ◽  
Andrea Costantini
Keyword(s):  
Chest Pain ◽  
Esophageal Motility ◽  
Current Knowledge ◽  
Unexpected Finding ◽  
Diffuse Esophageal Spasm ◽  
Extreme Caution ◽  
Motility Disorders ◽  
Diagnosis And Management ◽  
Chicago Classification ◽  
Esophageal Spasm

Spastic esophageal motility disorders are represented, as per the Chicago classification 4.0, by diffuse esophageal spasm and hypercontractile esophagus. They are very rare and therefore poorly understood. The diagnosis is usually made by manometry in presence of dysphagia or chest pain, but often it is often an unexpected finding. In this paper, the authors review the current knowledge and possible treatments of these disorders, when needed. They underline that invasive treatments, as surgical myotomy or POEM, are rarely necessary and that the indications for them are based on low quality studies. Therefore, they should be used with extreme caution in treating spastic motility disorders other than achalasia.

scholarly journals High Resolution Impedance Manometry: A Necessity or Luxury in Esophageal Motility Disorder?

2018 ◽  
Vol 19 ◽  
pp. 998-1003
Author(s):  
Han Sin Boo ◽  
Ian Chik ◽  
Chai Soon Ngiu ◽  
Shyang Yee Lim ◽  
Razman Jarmin
Keyword(s):  
High Resolution ◽  
Esophageal Motility ◽  
Motility Disorder ◽  
Esophageal Motility Disorder
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