비심인성 흉통환자에서 식도운동검사의 의의

• Published in: The Korean journal of gastroenterology Vol. 27; no. 4; pp. 381 - 387
• Main Authors: 송치욱, Chi Wook song, 구양서, Yang Suh Koo, 이홍식, Hong Sik Lee, 이상우, Sang Woo Lee, 최재현, Jai Hyun Choi, 김창덕, Chang Duck Kim, 류호상, Ho Sang Ryu, 현진해, Jin Hai Hyum
• Format: Journal Article
• Language: Korean
• Published: 대한소화기학회 01-01-1995
• Subjects: Chest pain; Esophageal motility disorder
• ISSN: 1598-9992

Background/Aims: Recently the esophagus is considered a major source of recurrent noncardiac chest pain to patients in whom exercise stress test and/or cardiac catheterization have excluded a cardiac etiology. To investigate the esophageal origin of noncardiac chest pain, esophageal motility tests including manometry, provocation test, and radioisotope esophahgeal transit study(RETS) were studied in patients with noncardiac chest pain. Methods: A total of l26 patients with noncardiac chest pain were assessed;they included 41 patients with normal coronary angiogram and 85 patients with normal noninvasive cardiac tests such as echocardiogram and exercise stress test done in Korea University Hospital from Feb. l993 to Aug. 1994. Results: 56 out of 126 patients(44.4%) with noncardiac chest pain had abnormal manometric findings which included 20(35.7%) nonspecific esophageal motility disorder, 17(30.4%) hypertensive lower esophageal sphincter, 9(16.1%) hypo- tensive lower esophageal sphincter, and 2(3.6%) nutcracker esophagus. Thirty eight out of 126(30.1 %) patients had abnormal manometric findings but no reproducible chest pain by provocation test and were considered to have a probable esophageal chest pain. When patients having positives for both provocation tests are counted as a single positive, 39 out of l26(3l /o) patients had their chest pain reproduced and were considered to have a defini(e esophageal chest pain. The combination of patients with definite esophageal chest pain(31%) and probable(30.17c) gave an overall diagnostic yield of 61.1% for our esophageal laboratory. There was no significant difference between invasive cardiac test group and noninvasive cardiac test group in the results of esophageal motility tests. RETS merely reflected the peristaltic abnonnalities with no more informations for esophageal chest pain. Conclusions: These results reveal that esophagus is considered a source of noncardiac chest pain in 61.1%. Provocation test complements esophageal manometry alone and increases diagnostic yield. RETS can be used in diagnosis of noncardiac chest pain accompanied by peristaltic abnormality of the esophagus. (Korean J Gastroenterol 1995;27:381-387)