Clinical Value of Esophageal Motility Testing

DiMarino, Anthony J.; Allen, Melvin L.; Lynn, Richard B.; Zamani, Saeed

doi:10.1159/000016867

Cited by 26 publications

(25 citation statements)

References 102 publications

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“…Data observing an effect of PPI therapy on chest pain associated with motility disorders [14] showed only a very minor effect on the respective motility disorder itself. These data indicate that dysmotility only is a facet or associated symptom of NCCP, not the main origin [15] .…”

Section: Discussionmentioning

confidence: 76%

Origin of and therapeutic approach to cardiac syndrome X: Results of the proton pump inhibitor therapy for angina-like lingering pain trial (PITFALL trial)

Dietrich¹,

Laupichler²,

Stanzel³

et al. 2008

WJG

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AIM:To investigate the frequency of gastroenterological diseases in the etiology and the efficacy of proton pump inhibitors (PPIs) in the treatment of cardiac syndrome X (CSX) as a subform of non-cardiac chest pain (NCCP). METHODS:We investigated 114 patients with CSX using symptom questionnaires. A subgroup of these patients were investigated regarding upper gastrointestinal disorders (GIs) and treated with PPI.Patients not willing to participate in investigation and treatment served as control group. RESULTS: Thirty-six patients denied any residual symptoms and were not further evaluated. After informed consent in 27 of the remaining 78 patients, we determined the prevalence of disorders of the upper GI tract and quantified the effect of treatment with pantoprazole. We found a high prevalence of gastroenterological pathologies (26/27 patients, 97%) with gastritis, gastroesophageal reflux disease (GERD) and acid reflux as the most common associated disorders. If treated according to the study protocol, these patients showed a significant improvement in the symptom score. Patients treated by primary care physicians, not according to the study protocol had a minor response to treatment (n = 19, -43%), while patients not treated at all (n = 26) had no improvement of symptoms (-0%). CONCLUSION: Disorders of the upper GI tract are a frequent origin of CSX in a German population and can be treated with pantoprazole if given for a longer period.

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Section: Discussionmentioning

confidence: 76%

Origin of and therapeutic approach to cardiac syndrome X: Results of the proton pump inhibitor therapy for angina-like lingering pain trial (PITFALL trial)

Dietrich¹,

Laupichler²,

Stanzel³

et al. 2008

WJG

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“…As DiMarino et al [1] note in their review, manometric testing is most often abnormal in patients presenting with dysphagia. In a prior review of 1,161 patients from our laboratory, abnormal manometry was found in 28% of patients presenting with chest pain and in 53% of patients presenting with dysphagia (p !…”

Section: Dysphagiamentioning

confidence: 98%

“…It seems appropriate at this time to reassess the clinical value of esophageal motility testing using today's modern techniques. In this issue of Digestive Diseases, DiMarino et al [1] provide such an overview and attempt to develop a concept of the role of the modern motility laboratory in the clinical arena. They have divided their review into an assessment of the use of manometry according to the three major presenting symptoms of esophageal diseases: heartburn, chest pain and dysphagia.…”

mentioning

confidence: 99%

Esophageal Manometry and Modern Medicine

Katzka¹,

Castell²

1998

Dig Dis

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“…truly due to esophageal 'spasm'. DiMarino et al [50] documented a symptomatic and manometric response to They found that 33% of the pain episodes were related to reflux, 23% to abnormal motility and 43% were normal both short-acting and long-acting nitrates. In another study by Kiendall and Mellow [51] it was suggested that [24].…”

Section: Therapy Directed Towards Motor Dysfunctionmentioning

confidence: 99%

Update on Noncardiac Chest Pain

Shrestha

Pasricha

2000

Dig Dis

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Patients with recurrent angina-like chest pain with normal coronary vessels are deemed to have the syndrome of noncardiac chest pain (NCCP). These patients, despite having significant cardiac disease ruled out, often spend a restricted lifestyle believing they have cardiac disease. These recurrent episodes of chest pain may be related to gastroesophageal reflux disease (GERD), spastic motility disorders of the esophagus and esophageal (visceral) hyperalgesia. These disease entities are often difficult to diagnose and treat except for GERD and achalasia. Recent prospective double-blind studies have shown that about 44% of these patients may have underlying GERD. There is now more evidence to support the practice of empiric use of proton pump inhibitors (PPIs) as the first step in therapy. Newer modalities for diagnosis like endoscopic ultrasonography (EUS) showed that this group of patients had sustained muscular contractions of longer that 68 s during chest pain. These sustained contractions noted on EUS were secondary to isometric contraction of the circular muscle which did not cause luminal constriction nor was related to contraction of the longitudinal muscles which cannot be recorded by pressure manometry. Treatment is difficult if patients do not respond to high-dose PPIs. Other medications which are known to alter visceral hyperalgesia in low doses, such as tricyclic antidepressants like imipramine and desyrel, can be tried. Psychological intervention may be useful in the management of some of these patients.

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Clinical Value of Esophageal Motility Testing

Cited by 26 publications

References 102 publications

Origin of and therapeutic approach to cardiac syndrome X: Results of the proton pump inhibitor therapy for angina-like lingering pain trial (PITFALL trial)

Origin of and therapeutic approach to cardiac syndrome X: Results of the proton pump inhibitor therapy for angina-like lingering pain trial (PITFALL trial)

Esophageal Manometry and Modern Medicine

Update on Noncardiac Chest Pain

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