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  • 1
    Electronic Resource
    Electronic Resource
    Edrophonium provocative test in noncardiac chest pain (1990)
    Springer
    Digestive diseases and sciences 35 (1990), S. 1445-1451 
    Details
    ISSN: 1573-2568
    Keywords: chest pain ; esophageal motility disorders ; edrophonium ; diffuse spasm
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Edrophonium chloride is used frequently as a provocative agent in the assessment of noncardiac chest pain (NCCP). However, the optimum dose and most appropriate method of interpreting test results is controversial. We studied 150 consecutive NCCP patients and 50 age-matched controls who alternately received either 80 μg/kg or 10 mg intravenous bolus doses of edrophonium preceded by saline placebo injections. Distal esophageal pressures were measured before and after drug injection in response to ten 5-cc wet swallows. Following 10 mg of edrophonium, 33% of patients and 4% of controls reported chest pain, while 29% of patients and no controls receiving the 80 μg/kg dose complained of chest pain. Amplitude changes after either dose were not significantly different for all comparisons, but the duration of response did distinguish the two doses in patients with chest pain. A significantly greater (P=0.01) increase in distal contraction duration occurred after 10 mg (74±12%; ±se) compared to 80 μg/kg dose (43± 6%). However, individual responses to the two doses overlapped considerably. If a positive test is redefined to include both chest pain and manometric changes that are significantly different from controls, the positivity rate changes drastically; 33% to 9% in the 10- mg group and 30% to 3% in the 80- μg/kg group. Side effects were similar between doses, but there was a significant (P=0.02) linear relationship between intensity of side effects and the edrophonium dose per kilogram of body weight. From this study and a review of the literature, we conclude that either dose of edrophonium is appropriate for provocative testing but that the interpretation of results is dependent upon technique.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01540560
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    Paper (German National Licenses)
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  • 2
    Electronic Resource
    Electronic Resource
    Comparison of esophageal manometry, provocative testing, and ambulatory monitoring in patients with unexplained chest pain (1990)
    Springer
    Digestive diseases and sciences 35 (1990), S. 302-309 
    Details
    ISSN: 1573-2568
    Keywords: gastroesophageal reflux disease ; esophageal motility disorders ; chest pain ; diffuse spasm
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Prolonged ambulatory esophageal pH and pressure monitors are being developed to evaluate noncardiac chest pain. This new technology needs comparison with conventional esophageal tests before determining which studies are most useful in diagnosing and treating esophageal chest pain. Therefore, we studied 45 patients with esophageal manometry, acid perfusion and edrophonium tests, and 24 hr pH and pressure monitoring. Manometry was abnormal in 20 patients (44%) with nutcracker esophagus, the most common motility disorder. Fifteen (33%) had positive acid perfusion test and 24 (55%) positive edrophonium test. During ambulatory monitoring, all patients experienced chest pain with a total of 202 individual events: 32 events (15%) secondary to acid reflux, 15 (7%) secondary to motility abnormalities, 7 (3%) to both pH and pressure changes, and 149 events (74%) occurred in the absence of any abnormal pH or motility changes. Patients with normal manometry were significantly (P〈0.01) more likely to have acid reflux chest pain events than did nutcracker patients, who had an equal frequency of pH and motility events. A positive acid perfusion test was significantly associated with abnormal pressure events (P=0.02; odds ratio 5.95), while a positive edrophonium test more likely predicted acid reflux chest pain during 24-hr monitoring (P=0.007; odds ratio 7.25). Therefore, abnormal manometry and positive provocative tests point to the esophagus as the likely source of chest pain. However, ambulatory pH and pressure monitoring are required to accurately define the relationship between chest pain and acid reflux or motility disorders. Acid reflux is the most common identifiable cause of esophageal chest pain, while motility disorders are much less frequent than previously suggested by laboratory tests.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01537406
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    Paper (German National Licenses)
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  • 3
    Electronic Resource
    Electronic Resource
    Acid perfusion test and 24-hour esophageal pH monitoring with symptom index (1991)
    Springer
    Digestive diseases and sciences 36 (1991), S. 565-571 
    Details
    ISSN: 1573-2568
    Keywords: gastroesophageal reflux ; chest pain ; acid perfusion test ; esophageal pH monitoring
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The acid perfusion (Bernstein) test and esophageal pH monitoring are the two most popular tests for identifying esophageal acid sensitivity in difficult cases of reflux disease. Therefore, we prospectively compared these test results in 75 consecutive noncardiac chest pain patients who had both an acid perfusion test and chest pain during 24-hr pH testing. A positive acid perfusion test was defined by the replication of the patient's typical chest pain twice by the acid infusion. Esophageal pH testing identified abnormal amounts of acid reflux and correlated symptoms with acid reflux-the “symptom index.” Fifteen patients (20%) had a positive acid perfusion test while 45 patients (59%) had a positive symptom index (range 6–100%). Only 9/34 (26%) patients with abnormal reflux had a positive acid perfusion test. Although it had excellent specificity (83–94%), the acid perfusion test had poor sensitivity (32–46%) when compared to the symptom index regardless of the percent positive cutoff level. The best positive predictive value for the acid perfusion test was 87%, but this occurred when the test sensitivity was 32%. Modifying the end point of a positive acid perfusion test to include heartburn improves the sensitivity (52–67%) while markedly compromising specificity and positive predictive value. Thus, esophageal pH monitoring correlating symptoms with acid reflux is superior to the acid perfusion test for identifying an acid sensitive esophagus in patients with noncardiac chest pain.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01297020
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    Paper (German National Licenses)
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  • 4
    Electronic Resource
    Electronic Resource
    Diffuse esophageal spasm (1991)
    Springer
    Digestive diseases and sciences 36 (1991), S. 1025-1028 
    Details
    ISSN: 1573-2568
    Keywords: esophagus ; motility disorder ; esophageal ; spasm
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Diffuse esophageal spasm (DES) has frequently been described as a motility disorder characterized by simultaneous, high-amplitude contractions. We reviewed the results of esophageal manometry testing on a total of 1480 patients referred to our lab over 36 months. Lower esophageal sphincter (LES) pressure was determined by a mean of four station pull-throughs. Esophageal body motility was assessed following 10 wet swallows. In our lab a diagnosis of DES is made when greater than 10% but less than 100% of contractions are simultaneous. Manometric findings of DES were rare, with an overall prevalence of 4% (56/1480). Of the 56 patients with a manometric diagnosis of DES, high-amplitude (X≥180 mm Hg) peristaltic contractions were found in only two (4%). No simultaneous contractions with amplitude ≥180 mm Hg were seen. Pressures of simultaneous contractions were consistently lower than peristaltic contractions. A hypertensive LES pressure (≥45 mm Hg) was present in 5/56 DES patients (9%). Poor LES relaxation was found in 7/56 DES patients (13%). We conclude that DES is a rare manometric finding, regardless of the reason for referral, and that the occurrence of high-amplitude contractions in DES is equally rare.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01297441
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    Paper (German National Licenses)
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