SEARCH

SEARCH BY CITATION

Summary

  1. Top of page
  2. Summary
  3. Introduction
  4. Methods
  5. The Clinical Outcomes Research Initiative
  6. Clinical Outcomes Research Initiative and oesophageal manometry
  7. Statistical analysis
  8. Results
  9. Patients and participating centres
  10. Distribution of oesophageal motility disorders within the different groups
  11. Association between medical centre type, age or gender and distribution of oesophageal motility disorders
  12. Discussion
  13. References

Background : Available prospectively acquired data on the distribution of oesophageal motor abnormalities in patients being evaluated for non-cardiac chest pain and/or dysphagia are relatively scarce.

Aim : To evaluate the distribution of oesophageal motor abnormalities in patients with dysphagia, non-cardiac chest pain or both using the national Clinical Outcomes Research Initiative (CORI) database.

Methods : The CORI oesophageal motility database originates from 19 community, university and VA medical centres. Data were collected using a computerized motility report-generating program, combined with the CORI module. Data from each site were encrypted and sent to the CORI National Repository for analysis. The database includes the assessment of the lower and upper oesophageal sphincter function and the motor activity of the oesophageal body.

Results : Five hundred and eighty-seven consecutive patients who underwent motility studies between 1998 and 2001 were included in the CORI database and analysed for this report. Four hundred and three patients (69%) had dysphagia as their primary indicator for the examination, 140 patients (24%) had non-cardiac chest pain and 44 patients (7%) had both dysphagia and non-cardiac chest pain. In all three groups, a normal motility study was the most frequent finding (dysphagia, 53%; chest pain, 70%; both, 55%). The most common motility abnormality in the group with non-cardiac chest pain was a hypotensive lower oesophageal sphincter (61%). Nutcracker oesophagus and non-specific oesophageal motility disorders were each diagnosed in only 10% of patients with non-cardiac chest pain. In patients with dysphagia, ineffective peristalsis was the most common oesophageal dysmotility (27%), followed by achalasia and non-specific oesophageal motility disorders (18% and 14%, respectively). Achalasia and non-specific oesophageal motility disorders were the most common oesophageal motility abnormalities in patients with both chest pain and dysphagia (35% and 25%, respectively).

Conclusions : The most common oesophageal motility abnormality in patients with non-cardiac chest pain is a hypotensive lower oesophageal sphincter; nutcracker oesophagus and non-specific oesophageal motility disorders are relatively uncommon; the most common oesophageal motility abnormality in patients with dysphagia is ineffective peristalsis and, for those with both dysphagia and non-cardiac chest pain, it is achalasia.


Introduction

  1. Top of page
  2. Summary
  3. Introduction
  4. Methods
  5. The Clinical Outcomes Research Initiative
  6. Clinical Outcomes Research Initiative and oesophageal manometry
  7. Statistical analysis
  8. Results
  9. Patients and participating centres
  10. Distribution of oesophageal motility disorders within the different groups
  11. Association between medical centre type, age or gender and distribution of oesophageal motility disorders
  12. Discussion
  13. References

Non-cardiac chest pain is defined by recurrent episodes of substernal chest pain in patients lacking a cardiac cause after a comprehensive evaluation.1 The exact magnitude of the problem is not known completely, but it is estimated that up to 25% of the general population experience non-cardiac chest pain at least once during their lifetime.2 Of those patients who present in ambulatory care or in the emergency room for the first time with chest pain, a cardiac aetiology is ultimately found in only 11–45%.3–5

The oesophagus is the most common source of non-cardiac chest pain, with gastro-oesophageal reflux disease accounting for up to 60% of cases.6, 7 Oesophageal motility abnormalities have been reported in up to 30% of patients with non-cardiac chest pain.6–8 Various manometric abnormalities have been described in patients with non-cardiac chest pain, but nutcracker oesophagus and non-specific oesophageal motility disorders are currently considered to be the most prevalent.8, 9

In the American Gastroenterology Association technical review on the clinical use of oesophageal manometry, 14 studies evaluating the distribution of motility abnormalities in non-cardiac chest pain were reviewed.10 The authors concluded that non-specific oesophageal motility disorder was by far the most frequent diagnosis, and, within this group, nutcracker oesophagus was the most commonly observed motility disorder. Most of the reports assessed were the findings of single tertiary referral centres.

Thus far, the largest study to evaluate the distribution of oesophageal motility abnormalities in non-cardiac chest pain included 910 patients seen in a single tertiary referral centre with a major interest in oesophageal motility.8 Although most of the patients evaluated had a normal oesophageal manometry, 28% demonstrated some type of motility abnormality, and nutcracker oesophagus was the most common diagnosis (48%). Non-specific oesophageal motility disorder was the second most common motility abnormality, affecting 36% of the patients with non-cardiac chest pain, followed by diffuse oesophageal spasm (10%). Based on this seminal work, nutcracker oesophagus is considered by many to be the most common oesophageal motility disorder found in patients with non-cardiac chest pain.

Dysphagia is another common oesophageal symptom which may be associated with oesophageal motility abnormalities. The prevalence of dysphagia in the general population is not well established, but several studies have suggested that between 7% and 10% of adults are affected.11, 12 Complaints about dysphagia appear to increase with age, but usually are not attributed to the ageing process itself.13 Dysphagia is not uncommonly associated with oesophageal manometric findings which may be present with chest pain symptoms as well.10

Motility abnormalities that have been described in patients with dysphagia include achalasia, diffuse oesophageal spasm, hypertensive lower oesophageal sphincter, nutcracker oesophagus and non-specific oesophageal motility disorder.8, 14 In the largest series of patients with dysphagia, Katz et al. reported that 53% had some type of oesophageal dysmotility.8 Non-specific oesophageal motility disorder was the most commonly reported diagnosis (39%), followed by achalasia (36%), diffuse oesophageal spasm (13%) and nutcracker oesophagus (10%).

We hypothesized that the prevalence of these described motility disorders was not an accurate measure of their prevalence today. Thus, the aims of this study were three-fold: (i) to determine the distribution of oesophageal motility abnormalities in patients with non-cardiac chest pain, dysphagia or both using the Clinical Outcomes Research Initiative (CORI) database which gathers oesophageal motility-related data from gastrointestinal private practices, Veteran Affairs Health Care Systems and university medical centres; this diverse set of medical centres offers a more heterogeneous patient population vs. the previous single tertiary centre studies; (ii) to determine whether demographic factors, such as age and gender, affect the distribution of oesophageal motor abnormalities in patients with non-cardiac chest pain, dysphagia or both; and (iii) to determine whether there is a centre effect on the distribution of oesophageal motility abnormalities reported in the different patient groups (non-cardiac chest pain, dysphagia or both).

The Clinical Outcomes Research Initiative

  1. Top of page
  2. Summary
  3. Introduction
  4. Methods
  5. The Clinical Outcomes Research Initiative
  6. Clinical Outcomes Research Initiative and oesophageal manometry
  7. Statistical analysis
  8. Results
  9. Patients and participating centres
  10. Distribution of oesophageal motility disorders within the different groups
  11. Association between medical centre type, age or gender and distribution of oesophageal motility disorders
  12. Discussion
  13. References

The CORI database was generated from 75 university medical centres, Veteran Affairs Health Care Systems and gastrointestinal private practices around the USA. The CORI system was established in 1995 as a mean to create a large databank from a variety of gastroenterology practices around the country. The CORI system gathers detailed information about the endoscopic procedures and manometric studies carried out in these practices. The data collected at each participating centre are transferred to a computerized report generator for an instant report, as well as to create a data file. All data files are transmitted electronically to a central computerized databank, which is subsequently queried to answer focused clinical questions. Each computerized file contains demographics, referral reasons, procedure description and procedure findings. Data files are anonymous to protect patient confidentiality.

Clinical Outcomes Research Initiative and oesophageal manometry

  1. Top of page
  2. Summary
  3. Introduction
  4. Methods
  5. The Clinical Outcomes Research Initiative
  6. Clinical Outcomes Research Initiative and oesophageal manometry
  7. Statistical analysis
  8. Results
  9. Patients and participating centres
  10. Distribution of oesophageal motility disorders within the different groups
  11. Association between medical centre type, age or gender and distribution of oesophageal motility disorders
  12. Discussion
  13. References

Presently, oesophageal motility-related data in CORI originate from 19 sites, including private practices, university medical centres and Veteran Affairs Health Care Systems. For the purpose of this study, oesophageal manometry-related data were collected for three groups of patients: those with chest pain, dysphagia or both chest pain and dysphagia.

The collected data from the CORI report included the type of medical centre, patient demographics and the study indication. Oesophageal manometry study results included information on the lower oesophageal sphincter, oesophageal body and upper oesophageal sphincter. Lower and upper oesophageal sphincter data included sphincter location and length, mean basal pressure and percentage relaxation during wet swallows. Oesophageal body assessment included the presence of peristalsis and the mean amplitude, velocity and duration of distal oesophageal contractions. In addition, the presence of non-transmitted, simultaneous, ineffective or hyperkinetic contractions was documented. Most of the oesophageal motility studies were performed by a water perfused system.

The CORI motility format specifically indicated the different necessary phases of the oesophageal manometry test. Objective data were collected in a standardized fashion, employing a user-friendly computer-based program.

The report of each oesophageal manometry study was systemically reviewed and interpreted by the authors to determine the presence and type of the oesophageal dysmotility described. The diagnosis of each oesophageal motility disorder was verified on the basis of the data provided by the reporting physicians and according to well-established published criteria15(Table 1).

Table 1.  Criteria used to diagnose primary oesophageal motility disorders
Type of motility disorderManometric criteria
  1. Adapted from Castell and Castell.15

Achalasia oesophagealAbsent peristalsis in oesophageal body with/without incomplete lower sphincter relaxation, or a hypertensive lower oesophageal sphincter
Diffuse oesophageal spasmSimultaneous contractions in ≥ 20% of wet swallows, with/without repetitive/prolonged/high-amplitude contractions, or lower oesophageal sphincter abnormalities (incomplete relaxation and high resting pressure)
Nutcracker oesophagusPeristaltic waves of high amplitude (mean > 180 mmHg)
Hypertensive lower oesophageal sphincterResting pressure > 45 mmHg
Hypotensive lower oesophageal sphincterResting pressure < 10 mmHg
Ineffective peristalsisLow-amplitude contractions (< 30 mmHg) in 30% or more of wet swallows
Non-specific oesophageal motility disorderAny combination of the following:
 non-transmitted contractions in ≥ 20% of swallows
 triple picked contractions
 retrograde contractions
 isolated, incomplete lower oesophageal sphincter relaxation
 Prolonged-duration peristaltic waves (> 6 s)

Statistical analysis

  1. Top of page
  2. Summary
  3. Introduction
  4. Methods
  5. The Clinical Outcomes Research Initiative
  6. Clinical Outcomes Research Initiative and oesophageal manometry
  7. Statistical analysis
  8. Results
  9. Patients and participating centres
  10. Distribution of oesophageal motility disorders within the different groups
  11. Association between medical centre type, age or gender and distribution of oesophageal motility disorders
  12. Discussion
  13. References

Relationships between any two categorical factors, such as centre type, presenting symptom group, diagnosis and gender, were evaluated using the chi-squared test. For example, we compared the distribution of presenting symptoms across the three types of medical centre. In order to compare the likelihood of a particular diagnosis being observed between the medical centre types, we compared the proportion of that diagnosis with all other diagnoses combined using a chi-squared test. Comparison of the mean ages between the levels of the aforementioned types of factor was made using analysis of variance (anova), including Scheffe two-way contrasts. A P value of less than 0.05 was considered to be significant.

Patients and participating centres

  1. Top of page
  2. Summary
  3. Introduction
  4. Methods
  5. The Clinical Outcomes Research Initiative
  6. Clinical Outcomes Research Initiative and oesophageal manometry
  7. Statistical analysis
  8. Results
  9. Patients and participating centres
  10. Distribution of oesophageal motility disorders within the different groups
  11. Association between medical centre type, age or gender and distribution of oesophageal motility disorders
  12. Discussion
  13. References

Five hundred and eighty-seven consecutive patients who underwent oesophageal manometry between the years 1998 and 2001 with an indication of non-cardiac chest pain, dysphagia or both were included in the CORI database and rigorously analysed. Patients were divided into three groups according to their oesophageal-related symptoms. Four hundred and three patients (69%) had dysphagia as their sole complaint (264 males; mean age, 57.0 ± 15.9 years; range, 14.5–89.8 years), 140 patients (24%) reported non-cardiac chest pain (58 males; mean age, 50.4 ± 13.3 years; range, 22.7–79.4 years) and 44 patients (7%) had both dysphagia and non-cardiac chest pain (26 males; mean age, 53.6 ± 14.5 years; range, 27.4–82.8 years). Patients who presented with chest pain were more likely to be females (58.6%), whereas patients presenting with dysphagia were more likely to be males (65%) (P = 0.001). Patients with non-cardiac chest pain were also on average 3.2 years younger than patients presenting with dysphagia and 6.4 years younger than patients presenting with both chest pain and dysphagia (P = 0.01 and P = 0.02, respectively).

Two hundred and eighty-six motility reports (49%) originated from university medical centres, 213 (36%) from Veteran Affairs Health Care Systems and 88 (15%) from private practice clinics. As expected, patients who were evaluated at Veteran Affairs Health Care Systems were more likely to be males and to be older than those who were evaluated at a university medical centre or private practice [92.9% vs. 40.6% and 37.5%, respectively (P < 0.0001), and 60.7 years vs. 52.4 and 52.8 years, respectively (P < 0.0001)]. The different types of practice sites differed in terms of patient demographics as well as the distribution of patient symptoms. Patients presenting to a Veteran Affairs Health Care System or university medical centre were more likely to have dysphagia as their primary indication for a referral to oesophageal manometry, when compared with patients in private practice (83% and 64% vs. 49%, respectively). Patients in private practice were more likely to have undergone oesophageal manometry for non-cardiac chest pain than those from Veteran Affairs Health Care Systems or university medical centres (43% vs. 11% and 27%, respectively). These differences in the distribution of patient indications for oesophageal manometry were statistically significant (P < 0.0001).

Distribution of oesophageal motility disorders within the different groups

  1. Top of page
  2. Summary
  3. Introduction
  4. Methods
  5. The Clinical Outcomes Research Initiative
  6. Clinical Outcomes Research Initiative and oesophageal manometry
  7. Statistical analysis
  8. Results
  9. Patients and participating centres
  10. Distribution of oesophageal motility disorders within the different groups
  11. Association between medical centre type, age or gender and distribution of oesophageal motility disorders
  12. Discussion
  13. References

In all three groups of patients (non-cardiac chest pain, dysphagia and both), a normal oesophageal motility study was the most frequent finding. A total of 70% of patients referred for non-cardiac chest pain, 53% for dysphagia and 55% for both dysphagia and non-cardiac chest pain were found to have a normal oesophageal manometry. The likelihood of finding any motility abnormality during oesophageal manometry was significantly higher in the dysphagia group than in patients with non-cardiac chest pain (47% vs. 30%, respectively, P < 0.0001).

In patients with dysphagia, the most common motility abnormality demonstrated was ineffective peristalsis, which was found in 50 patients (27%). Other less common motility abnormalities in patients with dysphagia were a hypotensive lower oesophageal sphincter (18%), achalasia (18%) and non-specific oesophageal motility disorder (14%) (Figure 1). Conversely, in patients with non-cardiac chest pain and abnormal oesophageal manometry, the most commonly demonstrated oesophageal motility abnormality was a hypotensive lower oesophageal sphincter (61%). Spastic motility disorders, such as nutcracker oesophagus, hypertensive lower oesophageal sphincter and diffuse oesophageal spasm, were much less common (10%, 10% and 2%, respectively) (Figure 2). The high percentage of patients with ineffective peristalsis in the dysphagia group (27%) was in sharp contrast with the relative rarity of this finding (5%) in patients with non-cardiac chest pain (P < 0.0001). Similarly, the percentage of patients with a hypotensive lower oesophageal sphincter in the non-cardiac chest pain group (61%) was significantly higher than that (18%) in the dysphagia group (P = 0.001).

image

Figure 1. Distribution of oesophageal motility abnormalities in 403 patients presenting with dysphagia only, using the Clinical Outcomes Research Initiative (CORI) national database. LES, lower oesophageal sphincter.

Download figure to PowerPoint

image

Figure 2. Distribution of oesophageal motility abnormalities in 140 patients presenting with non-cardiac chest pain only, using the Clinical Outcomes Research Initiative (CORI) national database. LES, lower oesophageal sphincter.

Download figure to PowerPoint

Patients who presented with both chest pain and dysphagia had a different distribution of oesophageal motility abnormalities, with achalasia and non-specific oesophageal motility disorders being the most frequent manometry findings (35% and 25%, respectively) (Figure 3).

image

Figure 3. Distribution of oesophageal motility abnormalities in 44 patients presenting with both non-cardiac chest pain and dysphagia, using the Clinical Outcomes Research Initiative (CORI) national database. LES, lower oesophageal sphincter.

Download figure to PowerPoint

Association between medical centre type, age or gender and distribution of oesophageal motility disorders

  1. Top of page
  2. Summary
  3. Introduction
  4. Methods
  5. The Clinical Outcomes Research Initiative
  6. Clinical Outcomes Research Initiative and oesophageal manometry
  7. Statistical analysis
  8. Results
  9. Patients and participating centres
  10. Distribution of oesophageal motility disorders within the different groups
  11. Association between medical centre type, age or gender and distribution of oesophageal motility disorders
  12. Discussion
  13. References

Private practices did not differ significantly from university medical centres or Veteran Affairs Health Care Systems in terms of the distribution of demonstrated oesophageal motility disorders (P = 0.1). However, the distribution of oesophageal motility disorders diagnosed at Veteran Affairs Health Care Systems for all indications was different from the distribution of oesophageal motility disorders diagnosed at university medical centres. Patients from university medical centres were more likely to have achalasia and a hypotensive lower oesophageal sphincter than patients from Veteran Affairs Health Care Systems (9.4% and 13.6% vs. 3.7% and 7%, respectively). In contrast, patients from Veteran Affairs Health Care Systems were more likely to have diffuse oesophageal spasm or nutcracker oesophagus (4.2% and 5.2% vs. 2.4% and 2.8%, respectively). These differences in the distribution of oesophageal motility findings between Veteran Affairs Health Care Systems and university medical centres were statistically significant (P = 0.001).

There was no significant relationship between the gender of the patient and the type of oesophageal motility disorder diagnosed (P = 0.72). In addition, there was no association between the age of the patient and the distribution of oesophageal motility disorders (P = 0.1). However, patients who were 60 years or older showed a significantly increased prevalence of nutcracker oesophagus than patients younger than 60 years of age (P = 0.03). Such a statistical relationship was not found for any of the other motility disorders or for the chance of having any motility abnormality.

Discussion

  1. Top of page
  2. Summary
  3. Introduction
  4. Methods
  5. The Clinical Outcomes Research Initiative
  6. Clinical Outcomes Research Initiative and oesophageal manometry
  7. Statistical analysis
  8. Results
  9. Patients and participating centres
  10. Distribution of oesophageal motility disorders within the different groups
  11. Association between medical centre type, age or gender and distribution of oesophageal motility disorders
  12. Discussion
  13. References

Previous studies that have assessed the distribution of oesophageal motility abnormalities in patients with non-cardiac chest pain and/or dysphagia have originated primarily from single tertiary referral centres. Commonly, the reporting medical centre had a special interest in oesophageal motility disorders. Thus, the results of these studies may not represent the true distribution of oesophageal motor disorders diagnosed in different types of health care centre across the country. The combination of a paucity of data and previous reports that were primarily obtained from single tertiary referral centres (thus limiting the generalizability of findings) was the impetus for the current study.

Our study was more diverse because we included patients referred for oesophageal manometry in different types of health care setting. Of the indications of interest, dysphagia alone was by far the most common reason (70%) for oesophageal manometry. In addition, this study demonstrated that a normal oesophageal motility was the most common finding (53.4–70%) regardless of the referral indication (dysphagia, non-cardiac chest pain or both). This finding is in agreement with previously published data.8 However, the distribution of oesophageal motility abnormalities diagnosed for the indications of interest revealed a different pattern than that previously described. In the current study, a hypotensive lower oesophageal sphincter was the most common motility finding in patients with non-cardiac chest pain (17.9%). In contrast, nutcracker oesophagus (2.9%) and non-specific oesophageal motility disorders (2.9%) were less commonly diagnosed. When assessing only those with abnormal motility studies, a hypotensive lower oesophageal sphincter was documented in 61% of patients with non-cardiac chest pain, whereas nutcracker oesophagus and non-specific oesophageal motility disorders were each diagnosed in only 10% of patients. These interesting findings are different from those reported by tertiary referral centres. In these centres, nutcracker oesophagus was documented in 27–48% and non-specific oesophageal motility disorders in 23–55% of patients with non-cardiac chest pain with oesophageal motility abnormalities.10 Katz et al. reported that nutcracker oesophagus was the most common (48%) oesophageal motility abnormality in patients with non-cardiac chest pain with oesophageal motility abnormalities, followed by non-specific oesophageal motility disorders (36%).8 No reference was made in this study to the percentage of patients with abnormally low basal lower oesophageal sphincter pressures. In the current study, basal lower oesophageal sphincter pressures were significantly lower in the chest pain group than in those with dysphagia. Low basal lower oesophageal sphincter pressures are known to facilitate gastro-oesophageal reflux. In addition, patients with non-cardiac chest pain commonly have gastro-oesophageal reflux disease as the underlying cause of their symptoms.2 It is possible that many of the patients in this study with a hypotensive lower oesophageal sphincter basal pressure suffered from gastro-oesophageal reflux disease-related non-cardiac chest pain. Our findings support the approach of a thorough exclusion of gastro-oesophageal reflux disease prior to evaluation for oesophageal motor abnormalities.2, 16 Empirical treatment with a double-dose proton pump inhibitor or the use of the proton pump inhibitor test is likely to reveal whether gastro-oesophageal reflux disease is the underlying cause of the patient's non-cardiac chest pain.1

Patients with dysphagia demonstrated a significantly higher percentage of abnormal oesophageal manometry studies when compared with patients with non-cardiac chest pain (47% vs. 30%, P < 0.0001). This finding is also in agreement with previous reports.8 Overall, the distribution of oesophageal motility abnormalities in patients with dysphagia was similar to that found in previous reports, although a lower percentage of achalasia was detected (18%).8 Hypotensive oesophageal motility disorders (ineffective peristalsis, achalasia and hypotensive lower oesophageal sphincter) were the most commonly diagnosed oesophageal motility disorders in dysphagia patients. Previous studies have included ineffective peristalsis as a subtype of non-specific oesophageal motility disorders, whereas recent studies have addressed these two disorders separately. In addition, our results also indicated the high association of ineffective peristalsis with dysphagia. This distinction was not noted in previous studies.

Our study suggests that oesophageal manometry plays a more prominent role in the evaluation of patients with dysphagia than in those with non-cardiac chest pain. However, oesophageal manometry results may lead to a possibly beneficial therapeutic intervention in only nine dysphagia patients (16.4%). This is primarily in those with achalasia, diffuse oesophageal spasm and, possibly, nutcracker oesophagus.

Patients with both chest pain and dysphagia had manometric findings that more closely resembled those of the dysphagia group than those of the non-cardiac chest pain group. Approximately one-half of patients had an abnormal oesophageal manometry, and achalasia and non-specific oesophageal motility disorder were the most commonly diagnosed findings (35% and 25%, respectively). Interestingly, this oesophageal motility distribution is very similar to that reported by Katz et al. for patients with dysphagia.8 Because Katz et al. did not include a group with both dysphagia and non-cardiac chest pain, it is possible that many of their patients with dysphagia as the indication for oesophageal manometry had non-cardiac chest pain as well.

Our study also demonstrated that patients at Veteran Affairs Health Care Systems had significantly different oesophageal motility abnormalities than those at university medical centres. This difference cannot be attributed to age or gender differences because these two demographic variables did not have any significant effect on the distribution of oesophageal motor abnormalities. Private practices did not differ from university medical centres or Veteran Affairs Health Care Systems in terms of the type of oesophageal dysmotility diagnosed. The latter may be related to the relatively low number of patients from private practices included in this analysis (15%).

The CORI database for oesophageal manometry may not represent the true distribution of oesophageal motility abnormalities in the community, as most of the studies originated from university medical centres and Veteran Affairs Health Care Systems. In addition, unlike endoscopy, the use of a computerized oesophageal manometry report-generating program (CORI) has yet to be popularized. However, this is the first study that has attempted to assess a diverse patient population referred for oesophageal manometry.

In summary, our study is the first to evaluate the distribution of oesophageal manometric findings in patients with chest pain, dysphagia or both, using a multi-centre database originating from diverse types of health care setting. It is clear that most patients with non-cardiac chest pain, dysphagia or both have a normal oesophageal manometry study. However, unlike previous reports, a hypotensive lower oesophageal sphincter is the most common manometric finding in patients with non-cardiac chest pain and ineffective peristalsis is the most common manometric finding in patients with dysphagia. In patients presenting with both non-cardiac chest pain and dysphagia, achalasia is the most common diagnosis.

References

  1. Top of page
  2. Summary
  3. Introduction
  4. Methods
  5. The Clinical Outcomes Research Initiative
  6. Clinical Outcomes Research Initiative and oesophageal manometry
  7. Statistical analysis
  8. Results
  9. Patients and participating centres
  10. Distribution of oesophageal motility disorders within the different groups
  11. Association between medical centre type, age or gender and distribution of oesophageal motility disorders
  12. Discussion
  13. References
  • 1
    Fass R, Fennerty MB, Ofman JJ, et al. The clinical and economic value of a short course of omeprazole in patients with noncardiac chest pain. Gastroenterology 1998; 115(1): 429.
  • 2
    Fass R. Chest pain of esophageal origin. Curr Opinion Gastroenterol 2002; 18: 46470.
  • 3
    Eslick GD, Talley NJ. Non-cardiac chest pain: squeezing the life out of Australian healthcare system? Med J Aust 2000; 173(5): 2334.
  • 4
    Katerndahl DA, Trammell C. Prevalence and recognition of panic states in STARNET patients presenting with chest pain. J Fam Pract 1997; 45(1): 5463.
  • 5
    Pope JH, Aufderheide TP, Ruthazer R, et al. Missed diagnoses of acute cardiac ischemia in the emergency department. N Engl J Med 2000; 342(16): 116370.
  • 6
    Cherian P, Smith LF, Bardhan KD, et al. Esophageal tests in the evaluation of non-cardiac chest pain. Dis Esophagus 1995; 8: 129.
  • 7
    Hewson EG, Sinclair JW, Dalton CB, Richter JE. Twenty-four-hour esophageal pH monitoring: the most useful test for evaluating noncardiac chest pain. Am J Med 1991; 90(5): 57683.
  • 8
    Katz PO, Dalton CB, Richter JE, Wu WC, Castell DO. Esophageal testing of patients with noncardiac chest pain or dysphagia. Ann Intern Med 1987; 106(4): 5937.
  • 9
    Richter JE. Noncardiac chest pain: use of esophageal manometry and provocative tests. In: CastellDO, CastellJA, eds. Esophageal Motility Testing, 2nd edn. Norwalk, CT: Appleton & Lange, 1994: 14862.
  • 10
    Kahrilas PJ, Clouse RE, Hogan WJ. American Gastroenterological Association technical review on the clinical use of esophageal manometry. Gastroenterology 1994; 107(6): 186584.
  • 11
    Trate DM, Parkman HP, Fisher RS. Dysphagia. Evaluation, diagnosis, and treatment. Prim Care 1996; 23(3): 41732.
  • 12
    Ruth M, Mansson I, Sandberg N. The prevalence of symptoms suggestive of esophageal disorders. Scand J Gastroenterol 1991; 26(1): 7381.
  • 13
    Lindgren S, Janzon L. Prevalence of swallowing complaints and clinical findings among 50–79-year-old men and women in an urban population. Dysphagia 1991; 6(4): 18792.
  • 14
    Fass R. Approach to the patient with dysphagia. UpToDate 2003 uptodateonline.com.
  • 15
    Castell DO, Castell JA. Esophageal Motility Testing, 2nd edn. Norwalk, CT: Appleton & Lange, 1994.
  • 16
    Castell DO. Chest pain of esophageal origin. UpToDate 2003 uptodateonline.com.