title: The incidence of gastro-esophageal disease for the patients with typical chest pain and a normal coronary angiogram.
abstract: BACKGROUND
  Although patients may present with typical chest pain and exhibit ischemic changes on the cardiac stress test, they are frequently found to have a normal coronary angiogram. Thus, we wanted to determine which procedures should be performed in order to make an adequate diagnosis of the cause of chest pain.
  
  
  METHODS
  121 patients (males: 42, 34.7%) who had a normal coronary angiogram with typical chest pain were included in this study. All the patients underwent upper endoscopy, Bernstein's test and esophageal manometry.
  
  
  RESULTS
  Among the 121 patients, clinically stable angina was noted in 107 (88.4%). Stress testing was done in 82 (67.8%); it was positive in 52 (63.4%). Endoscopic findings were erosive gastritis in 18 (14.8%), gastric ulcer in 4 (3.3%), duodenal ulcer in 5 (4.1%), and reflux esophagitis in 16 (13.2%). Positive results were observed on Berstein's test for 68 patients (56.2%); 59 (86.8%) of them had non-erosive reflux disease. On the esophageal manometry, 35 (28.9%) of these patients had motility disorders. Nutcracker esophagus was observed in 27 patients (22.3%), nonspecific esophageal motility disorder was observed in 5 (4.1%), and hypertensive lower esophageal sphincter was observed in 3 (2.5%). Among the 52 patients with positive cardiac stress testing and a negative coronary angiogram (this clinically corresponded to microvascular angina), 46 patients (85.1%) showed abnormal findings on the gastro-esophageal studies.
  
  
  CONCLUSIONS
  In our study, 85.1% of the patients with microvascular angina revealed positive results of gastric or esophageal disease. In spite of any existing evidence of microvascular angina or cardiac syndrome X, it would be more advisable to perform gastro-esophageal studies to adequately manage chest pain.
authors.affiliation: Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea.
authors.forename: Chang-Wook
authors.initials: CW
authors.lastname: Nam
authors.forename: Kee-Sik
authors.initials: KS
authors.lastname: Kim
authors.forename: Young-Soo
authors.initials: YS
authors.lastname: Lee
authors.forename: Sang-Hoon
authors.initials: SH
authors.lastname: Lee
authors.forename: Seong-Wook
authors.initials: SW
authors.lastname: Han
authors.forename: Seung-Ho
authors.initials: SH
authors.lastname: Hur
authors.forename: Yoon-Nyun
authors.initials: YN
authors.lastname: Kim
authors.forename: Kwon-Bae
authors.initials: KB
authors.lastname: Kim
authors.forename: Byoung-Kuk
authors.initials: BK
authors.lastname: Jang
mesh_terms: D000328:Adult; D000368:Aged; D002637:Chest Pain / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology*; D017023:Coronary Angiography; D004935:Esophageal Diseases / Q000150:complications* / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013272:Stomach Diseases / Q000150:complications* / Q000453:epidemiology