Investigation of esophageal sensation and biomechanical properties in functional chest pain.
BACKGROUND
There is limited and conflicting data regarding the role of esophageal hypersensitivity in the pathogenesis of functional chest pain (FCP). We examined esophageal sensori-motor properties, mechanics, and symptoms in subjects with FCP.


METHODS
Esophageal balloon distension test was performed using impedance planimetry in 189 (m/f = 57/132) consecutive subjects with non-cardiac, non-reflux chest pain, and 36 (m/f = 16/20) healthy controls. The biomechanical and sensory properties of subjects with and without esophageal hypersensitivity were compared with controls. The frequency, intensity, and duration of chest pain were assessed.


RESULTS
One hundred and forty-three (75%) subjects had esophageal hypersensitivity and 46 (25%) had normal sensitivity. Typical chest pain was reproduced in 105/143 (74%) subjects. Subjects with hypersensitivity demonstrated larger cross-sectional area (P < 0.001), decreased esophageal wall strain (P < 0.001) and distensibility (P < 0.001), and lower thresholds for perception (P < 0.01), discomfort (P < 0.01), and pain (P < 0.01) compared to those without hypersensitivity or healthy controls. Chest pain scores (mean +/- SD) for frequency, intensity and duration were 2.5 +/- 0.3, 2.2 +/- 0.2, and 2.2 +/- 0.2, respectively, and were similar between the two patient groups.


CONCLUSIONS
Seventy-five per cent of subjects with FCP demonstrate esophageal hypersensitivity. Visceral hyperalgesia and sensori-motor dysfunction of the esophagus play a key role in the pathogenesis of chest pain.
Nasr
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Department of Internal Medicine, University of Iowa Carver College of medicine, Iowa City, IA, USA.
Attaluri
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Hashmi
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Gregersen
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Rao
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D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001696:Biomechanical Phenomena; D002404:Catheterization; D002637:Chest Pain / Q000209:etiology / Q000503:physiopathology*; D017097:Electric Impedance; D004935:Esophageal Diseases / Q000150:complications / Q000503:physiopathology*; D004947:Esophagus / Q000503:physiopathology*; D005260:Female; D006801:Humans; D006967:Hypersensitivity; D008297:Male; D008365:Manometry; D008875:Middle Aged; D010147:Pain Measurement; D018579:Patient Selection; D010812:Physical Stimulation; D011446:Prospective Studies; D012684:Sensory Thresholds; D012720:Severity of Illness Index