Oesophageal Ischaemia in Motility Disorders Associated With Chest Pain

MacKenzie, J. F.; Land, D.V.; Belch, J. J. F.; Park, Richard; McKillop, James H.

doi:10.1016/s0140-6736(88)90638-1

Cited by 51 publications

(16 citation statements)

References 21 publications

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“…Motility disorders such as diffuse oesophageal spasm and achalasia can stimulate mechanoreceptors provoking NCCP. The exact pathophysiology is uncertain, but the concept of oesophageal spasm causing ischaemic pain is no longer favoured (26–28).…”

Section: Cardiac Manifestations Of Gordmentioning

confidence: 99%

A review of the atypical manifestations of gastroesophageal reflux disease

Chandra

Moazzez

Bartlett

et al. 2004

International Journal of Clinical Practice

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Manifestations of atypical gastroesophageal reflux disease (GORD) are varied, and the presentation of atypical symptoms may occur in the absence of typical symptoms. The most sensitive and specific investigation for GORD is pH monitoring, and its application in atypical disease is utilized throughout this paper as a basis for correlating disease and pathogenesis. The less well-known areas of laryngeal manifestations, particularly chronic hoarseness and globus, are discussed in addition to recent work on orodental manifestations. Well-known areas of cardiac and respiratory manifestations, which include chronic cough and asthma, are also reviewed. Evidence from clinical trials indicates that aggressive anti-reflux therapy in patients with atypical symptoms can be effective. Where appropriate, medical therapy may involve long-term proton pump inhibitor, although further research outlining the roles of other therapies such as surgery is awaited.

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Section: Cardiac Manifestations Of Gordmentioning

confidence: 99%

A review of the atypical manifestations of gastroesophageal reflux disease

Chandra

Moazzez

Bartlett

et al. 2004

International Journal of Clinical Practice

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“…Another vascular cause of angina-like chest pain could be a coincidence of microvascular angina and nutcracker esophagus [47]. This is affirmed in a study by Mackenzie in which esophageal ischemia, explained by a local vasospasm following a low-temperature stimulus, was observed and considered to be responsible for the pain [48].…”

Section: Angina-like Chest Painmentioning

confidence: 86%

The gastroenterologist's approach to dysphagia

et al. 1993

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In the gastroenterological diagnostic armamentarium, dysphagia is considered as an important symptom for diseases of the esophagus. Concerning the history of illness, symptoms such as retrosternal pain and heartburn are often associated with gastroesophageal reflux disease. Morphological changes of the mucosa can be diagnosed by flexible endoscopy and radiographic examinations. Investigation with 24-h pH monitoring, manometry, and pharmacological tests is necessary for the diagnosis of functional disorders. Additionally, dysphagia can be associated with multiple internal diseases, including muscular diseases such as dermatomyositis, progressive systemic sclerosis, as well as lupus erythematosus. Difficulties in swallowing associated with hypo- and hyperthyroidism can also be interpreted as muscular lesions. Metabolic disorders such as alcoholism, and diabetes mellitus can be the cause of dysphagia. Increasing importance in the differential diagnosis of dysphagia is attached to infections of the upper GI tract. Especially in immunocompromised patients, infections of Candida albicans, mycobacterias, herpes, varicella zoster, and cytomegaloviruses can produce dysphagia and odynophagia. The differential diagnosis of the "angina-like chest pain" has to differentiate between cardiac disease and a noncardiac genesis. Therefore, besides the cardiac diagnostic investigation, endoscopy, radiography, and manometry are often indicated.

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“…Other studies underlining the association of spasm with chest pain described patients that really would be termed nutcracker oesophagus or possibly “spastic nutcracker” by our criteria [23, 24]. These patients may suffer from chest pain due to muscular ischemia [25] rather benefitting from amplitude reduction versus patients with bolus transit defects and lower contraction amplitudes, who might even experience worsening of their condition with such treatment. Spasm was an incidental finding in the majority of our patients classified as DES that were being tested in the evaluation for GERD related symptoms.…”

Section: Discussionmentioning

confidence: 99%

Functional aspects of distal oesophageal spasm: The role of onset velocity and contraction amplitude on bolus transit

Pohl

Ciolino

Roberts

et al. 2012

Digestive and Liver Disease

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Background Distal oesophageal spasm (DES) is a rare and under-investigated motility abnormality. Recent studies indicate effective bolus transit in varying percentages of DES patients. Aim Explore functional aspects including contraction onset velocity and contraction amplitude cut-off values for simultaneous contractions to predict complete bolus transit Methods We re-examined data from 107 impedance-manometry recordings with a diagnosis of DES. Receiver operating characteristic (ROC) analysis was conducted, regarding effects of onset velocity on bolus transit taking into account distal oesophageal amplitude (DEA) and correcting for intra-individual repeated measures. Results Mean area under the ROC curve for saline and viscous swallows were 0.84±0.05 and 0.84±0.04, respectively. Velocity criteria of >30cm/s when DEA>100mmHg and 8cm/s when DEA<100mmHg for saline and 32cm/s when DEA>100mmHg and >7cm/s when DEA<100mmHg for viscous had a sensitivity of 75% and specificity of 80% to identify complete bolus transit. Using these criteria, final diagnosis changed in 44.9% of patients. Abnormal bolus transit was observed in 50.9% of newly diagnosed DES patients versus 7.5% of patients classified as normal. DES patients with DEA>100mmHg suffered twice as often from chest pain than those with DEA<100mmHg. Conclusion The proposed velocity cut-offs for diagnosing distal oesophageal spasm improve the ability to identify patients with spasm and abnormal bolus transit.

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Oesophageal Ischaemia in Motility Disorders Associated With Chest Pain

Cited by 51 publications

References 21 publications

A review of the atypical manifestations of gastroesophageal reflux disease

A review of the atypical manifestations of gastroesophageal reflux disease

The gastroenterologist's approach to dysphagia

Functional aspects of distal oesophageal spasm: The role of onset velocity and contraction amplitude on bolus transit

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