Diagnostic utility of the oesophageal balloon distension test in the evaluation of oesophageal chest pain

Abstract

SUMMARY 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. Aim 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.

Visceral hypersensitivity is associated with GI symptom severity in functional GI disorders: consistent findings from five different patient cohorts

“…In FD, large-scale studies have demonstrated an association with pain predominance,7 18 and in patients with non-cardiac chest pain, oesophageal hypersensitivity can be found in approximately a third of the patients 19. In IBS, an association with the overall severity of IBS symptoms have been found in several large studies,15 16 21 34 and among the individual IBS symptoms the most consistent associations have been demonstrated with pain and bloating 16 34.…”

“…To obtain comparable scales for the overall GI symptom severity in all five cohorts, z scores were calculated and used when displaying the results for GI (IBS and dyspepsia) severity. Based on information from the literature with a third of patients on average demonstrating visceral hypersensitivity in FGIDs,7 8 19 21 the subjects in the five cohorts were divided into sensitivity tertiles based on their pain (IBS studies) or discomfort thresholds (FD cohort). GI symptom severity was compared between these sensitivity tertile groups using one-way analysis of variance (ANOVA) with post hoc pairwise comparisons between all three groups using independent samples t-tests with Bonferroni correction for multiple testing, as well as one-way between-groups ANOVA with linear contrast analyses to analyse the presence of a linear trend.…”

“…Since then numerous studies have verified the presence of visceral hypersensitivity in IBS,15–17 and also in other FGIDs such as FD18 and functional chest pain 19 20. However, not all patients with FGIDs demonstrate visceral hypersensitivity, and in large-scale studies approximately one-third of patients with FGIDs seem to demonstrate visceral hypersensitivity based on normal values in healthy individuals 7 8 19 21. Moreover, the presence of hypersensitivity to balloon distension provides no information about the underlying mechanism and its anatomical location since peripheral as well as central factors may be responsible for visceral hypersensitivity 22…”

“…The relevance of the concept of visceral hypersensitivity for FGIDs was first described in the early 1970s by James Ritchie, who demonstrated that patients with IBS were more sensitive to balloon distensions in the sigmoid colon than healthy controls 14. Since then numerous studies have verified the presence of visceral hypersensitivity in IBS,15–17 and also in other FGIDs such as FD18 and functional chest pain 19 20. However, not all patients with FGIDs demonstrate visceral hypersensitivity, and in large-scale studies approximately one-third of patients with FGIDs seem to demonstrate visceral hypersensitivity based on normal values in healthy individuals 7 8 19 21.…”

Noncardiac Chest Pain: Update on the Diagnosis and Management

“…70 When esophageal balloon distension test was performed after excluding GERD and achalasia from 332 NCCP patients, hypersensitivity was found in 71% (128/181) of the remaining patients. 21 When esophageal motility disorders other than achalasia were also ex- In a recent systematic review of published trials regarding effects of antidepressants on non-GERD−related NCCP, 74 6…”