title: A prospective study of oesophageal function in patients with normal coronary angiograms and controls with angina.
abstract: OBJECTIVE
  To compare the incidence of oesophageal abnormalities and their correlation with chest pain in patients with normal coronary angiograms, and in controls with angina.
  
  
  METHODS
  Sixty one patients with normal coronary angiograms (NCA group) referred to a single cardiac centre between March 1990 and April 1991; 25 matched controls with confirmed coronary artery disease (CAD group).
  
  
  METHODS
  Cardiac referral centre and oesophageal function testing laboratory.
  
  
  METHODS
  Oesophageal manometry, provocation tests, and 24 hour ambulatory pH monitoring.
  
  
  RESULTS
  Simultaneous contractions were more common (6.7% versus 0.8%, p < 0.01), and the duration of peristaltic contractions was longer (2.9 versus 2.4 seconds, p < 0.01) in the NCA group than in the CAD group. There were no group differences in the amplitude of peristaltic contractions, and none had nutcracker oesophagus. Ten (16%) patients with NCA and no patients with CAD had diffuse spasm (p = 0.03). Twenty one (34%) patients with NCA, and five (20%) patients with CAD had abnormal gastro-oesophageal reflux (p > 0.05). There was no significant difference between the groups in the number of patients whose pain was temporally related to pH events. Particular chest pain characteristics, or the presence of additional oesophageal symptoms, were not predictive of an oesophageal abnormality.
  
  
  CONCLUSIONS
  Oesophageal function tests commonly implicate the oesophagus as a source of pain in patients with normal coronary angiograms. With the exception of simultaneous contractions during manometry however, the incidence of abnormalities and in particular the correlation of pH events with chest pain are as common in patients with normal coronary angiograms as in controls with angina. The oesophagus may often be an unrecognised source of pain in both groups of patients.
authors.affiliation: Department of Cardiology, Guy's Hospital, London, UK.
authors.forename: R A
authors.initials: RA
authors.lastname: Cooke
authors.forename: A
authors.initials: A
authors.lastname: Anggiansah
authors.forename: J B
authors.initials: JB
authors.lastname: Chambers
authors.forename: W J
authors.initials: WJ
authors.lastname: Owen
mesh_terms: D000787:Angina Pectoris / Q000503:physiopathology*; D016022:Case-Control Studies; D002637:Chest Pain / Q000503:physiopathology*; D002800:Cholinesterase Inhibitors; D017023:Coronary Angiography; D004491:Edrophonium; D004947:Esophagus / Q000503:physiopathology*; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008365:Manometry; D008875:Middle Aged; D018670:Monitoring, Ambulatory; D011446:Prospective Studies
chemical_list: D002800:Cholinesterase Inhibitors; D004491:Edrophonium