The clinical utility of provocative radionuclide oesophageal transit in the evaluation of non-cardiac chest pain.
We combined edrophonium provocative testing with the technique of radionuclide oesophageal transit (RET) in 30 consecutive patients with non-cardiac chest pain (NCCP) and 12 controls. The oesophageal transit time of aqueous technetium-99m sulfur colloid was determined before and after intravenous infusion of 80 micrograms/kg edrophonium chloride (ED). Patient symptoms during provocative RET (P-RET) were recorded. Thirteen (43%) of the patients had abnormal study results, whereas all control subjects had normal results. Three groups considered abnormal were observed: (a) in two patients (6%), the pain was reproduced and transit pre- and post-ED administration was prolonged (greater than 15 s); (b) in six patients (20%), the pain was reproduced, but transit was normal pre- and post-ED; (c) in five patients (17%), transit pre- and post-ED was prolonged, but no pain was reproduced. In five patients (17%), ED prolonged the transit time greater than 15 s without pain, but the baseline transit was normal. Transit time was measurable in 23 patients. Mean pre-ED transit time was 10.2 +/- 7.4 s (mean +/- SD) and post-ED, 12.4 +/- 8.0 s (P = 0.3). We conclude that ED has no significant effect on transit time, and the pain induced by ED rarely correlates with an abnormal transit; P-RET provides additional information to baseline RET, increasing sensitivity, and may be a useful screening method in the evaluation of patients with NCCP.
Elloway
R S
RS
Department of Internal Medicine, Kettering Medical Center, Dayton, Ohio.
Jacobs
M P
MP
Nathan
M F
MF
Mantil
J C
JC
D002637:Chest Pain / Q000209:etiology*; D004491:Edrophonium; D004935:Esophageal Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D015154:Esophageal Motility Disorders / Q000150:complications / Q000000981:diagnostic imaging*; D004947:Esophagus / Q000000981:diagnostic imaging* / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010528:Peristalsis / Q000502:physiology; D011877:Radionuclide Imaging; D013671:Technetium Tc 99m Sulfur Colloid
D013671:Technetium Tc 99m Sulfur Colloid; D004491:Edrophonium