title: Diagnostic utility of the oesophageal balloon distension test in the evaluation of oesophageal chest pain.
abstract: BACKGROUND
  Oesophageal balloon distension test (EBDT) has been advocated for the evaluation of functional oesophageal noncardiac chest pain (NCCP), but its diagnostic utility remains unclear.
  
  
  OBJECTIVE
  To prospectively assess the diagnostic yield of EBDT in clinical practice and compare its yield with standard oesophageal tests.
  
  
  METHODS
  Over a period of 6 years, patients with chest pain and negative cardiac work-up underwent sequential testing with endoscopy/biopsy, oesophageal manometry, 24 h pH study and EBDT to elucidate an oesophageal source for their symptoms. Patients with a definite abnormality, for example, erosive oesophagitis on oesophagogastroduodenoscopy (EGD) were designated as having positive test and excluded from further work up.
  
  
  RESULTS
  Of 348 (m/f = 105/243) suspected NCCP patients, 16 (5%) were excluded; 332 (95%) underwent oesophageal testing. Among these, 48 (14%) had macro/microscopic oesophagitis on endoscopy, 7 (2%) had achalasia and 96 (28%) had excessive acid reflux (pH study). The remaining 181 (52%) patients underwent EBDT; 128 (37%) had oesophageal hypersensitivity. Chest pain was reproduced in 97/128 (75%) subjects. There were no adverse effects.
  
  
  CONCLUSIONS
  Oesophageal testing can reveal an oesophageal source for chest pain in 86% of NCCP subjects. The majority (42%) of patients had gastro-oesophageal reflux disease (GERD). Oesophageal balloon distension test identified hypersensitivity in over one-third of subjects. The oesophageal balloon distension test provides useful diagnostic information and should be performed routinely in patients with NCCP after excluding GERD.
authors.affiliation: University of Iowa Hospitals and Clinics, Iowa City, USA.
authors.forename: I
authors.initials: I
authors.lastname: Nasr
authors.forename: A
authors.initials: A
authors.lastname: Attaluri
authors.forename: E
authors.initials: E
authors.lastname: Coss-Adame
authors.forename: S S C
authors.initials: SS
authors.lastname: Rao
mesh_terms: D002404:Catheterization / Q000379:methods; D002637:Chest Pain / Q000175:diagnosis* / Q000209:etiology; D004108:Dilatation, Pathologic; D016145:Endoscopy, Digestive System / Q000379:methods; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index