Esophageal dysfunction and chest pain in patients with mitral valve prolapse: a prospective study utilizing provocative testing during esophageal manometry.
OBJECTIVE
The cause of chest discomfort in patients with mitral valve prolapse (MVP) remains unknown. Our aim was to determine prospectively the incidence of esophageal disorders and abnormal responses to edrophonium chloride and esophageal acid infusions in patients with MVP and troublesome non-ischemic chest pain.


METHODS
After coronary artery disease was excluded, 20 patients with MVP and chest pain underwent esophageal manometry and provocative testing with edrophonium chloride and acid infusion. Seven patients with MVP but without chest pain served as control subjects; they also underwent esophageal manometry with provocative testing.


RESULTS
Esophageal manometry revealed esophageal disorders in 16 patients: diffuse esophageal spasm in 14 patients, nutcracker esophagus in one, and hypotensive lower esophageal sphincter in one. Esophageal motility was normal in four patients. Injection of edrophonium and acid infusion tests evoked typical chest discomfort in three of 18 and five of 19 patients, respectively. In six of seven control subjects with MVP but with no chest discomfort, esophageal motility was normal and provocative testing did not produce chest discomfort (p less than 0.05 versus results in patients).


CONCLUSIONS
Esophageal disorders were common and may account for chest discomfort in certain patients with MVP and persistent chest pain syndromes.
Koch
K L
KL
Division of Gastroenterology, University Hospital, College of Medicine, Milton S. Hershey Medical Center, Pennsylvania State University, Hershey 17033.
Davidson
W R
WR
Day
F P
FP
Spears
P F
PF
Voss
S R
SR
D000328:Adult; D000368:Aged; D002637:Chest Pain / Q000209:etiology*; D004452:Echocardiography; D004491:Edrophonium; D015154:Esophageal Motility Disorders / Q000150:complications*; D004947:Esophagus / Q000502:physiology*; D005260:Female; D006801:Humans; D006851:Hydrochloric Acid; D008297:Male; D008365:Manometry; D008875:Middle Aged; D008945:Mitral Valve Prolapse / Q000150:complications*; D011446:Prospective Studies
D004491:Edrophonium; D006851:Hydrochloric Acid