title: Utility of upper endoscopy in the evaluation of noncardiac chest pain.
abstract: The diagnostic yield of esophagogastroduodenoscopy, esophageal manometry, and Bernstein testing was assessed in 100 consecutive patients being evaluated for non-cardiac chest pain. Manometric studies revealed the nutcracker esophagus in 21 patients; non-specific esophageal motility disorders in 19 patients; a hypertensive lower esophageal sphincter in 4 patients; diffuse esophageal spasm in 2 patients; and normal motility in 54 patients. Endoscopy was normal in 38 patients; but revealed grades II to IV esophagitis in 24 patients; gastritis and/or duodenitis in 18 patients; a sliding hiatal hernia without evidence of esophagitis in 14 patients; and gastric or duodenal ulcers in 6 patients. Twenty-five individuals were found to have normal manometric studies in combination with a negative Bernstein test. Among these 25 patients, however, 7 patients had esophagitis (grade II or higher); 6 patients had gastritis and/or duodenitis; five patients had a sliding hiatal hernia without esophagitis; 1 patient had peptic ulcer disease; and only 6 patients had a normal endoscopic exam. Our results indicate that endoscopy can identify a significant number of patients with acid-peptic disease who present with non-cardiac chest pain, that would not have been otherwise diagnosed by esophageal manometry or Bernstein testing alone or in combination.
authors.affiliation: Department of Medicine, Georgetown University Hospital, Washington, D.C. 20007.
authors.forename: P C
authors.initials: PC
authors.lastname: Hsia
authors.forename: K A
authors.initials: KA
authors.lastname: Maher
authors.forename: J H
authors.initials: JH
authors.lastname: Lewis
authors.forename: E L
authors.initials: EL
authors.lastname: Cattau
authors.forename: D E
authors.initials: DE
authors.lastname: Fleischer
authors.forename: S B
authors.initials: SB
authors.lastname: Benjamin
mesh_terms: D002637:Chest Pain / Q000209:etiology*; D004382:Duodenitis / Q000150:complications / Q000175:diagnosis; D016145:Endoscopy, Digestive System; D015154:Esophageal Motility Disorders / Q000150:complications / Q000175:diagnosis*; D004941:Esophagitis / Q000150:complications / Q000175:diagnosis*; D004947:Esophagus / Q000502:physiology; D005260:Female; D005756:Gastritis / Q000150:complications / Q000175:diagnosis; D006551:Hernia, Hiatal / Q000150:complications / Q000175:diagnosis; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged