title: Increasing pain sensation to repeated esophageal balloon distension in patients with chest pain of undetermined etiology.
abstract: Previous studies have demonstrated lowered sensory thresholds to esophageal balloon distension in patients with chest pain of undetermined etiology. Whether this finding is specific to patients with chest pain or is simply related to an underlying esophageal motility disorder is unclear. In the present study, distension-induced pain-sensation scores and the effect of repeated balloon distension were compared in patients with chest pain, dysphagia secondary to esophageal dysmotility, and healthy controls. All subjects underwent standard esophageal manometry followed by mid-esophageal balloon distension. Volumes 2.5, 5, 7.5, and 10 ml (each volume repeated three times) were applied in random order in a single-blind fashion, and the pain-sensation score was recorded after each distension. Pain-sensation scores varied directly with balloon volume. Mean pain scores were significantly higher (P < 0.001) in the chest pain group than in either the controls or dysphagia group. There was no significant difference between controls and the dysphagia group, and the motor response to distension was no different between groups. In the controls and dysphagia groups, pain-sensation score was not significantly different between the first, second, or third distension at a given volume. However, in the chest pain group, pain-sensation scores increased significantly with the second (P = 0.004) or third (P = 0.002) distension using the same balloon volume. These studies suggest that abnormal esophageal nociception in patients with chest pain of undetermined etiology is not simply related to underlying esophageal motor dysfunction. In addition, chest pain patients display a conditioning phenomenon, further supporting the presence of a visceral sensory abnormality.
authors.affiliation: GI Diseases Research Unit, Queen's University, Kingston, Ontario, Canada.
authors.forename: W G
authors.initials: WG
authors.lastname: Paterson
authors.forename: H
authors.initials: H
authors.lastname: Wang
authors.forename: S J
authors.initials: SJ
authors.lastname: Vanner
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002404:Catheterization / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data; D002637:Chest Pain / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D003680:Deglutition Disorders / Q000503:physiopathology; D004947:Esophagus / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D010147:Pain Measurement / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data; D017288:Pain Threshold / Q000502:physiology*; D016037:Single-Blind Method; D018709:Statistics, Nonparametric