Hewson E G, Sinclair J W, Dalton C B, Richter J E
Gastroenterology Division, Bowman Gray School of Medicine, Winston-Salem, North Carolina.
Am J Med. 1991 May;90(5):576-83.
To compare the diagnostic capabilities of traditional esophageal tests (manometry and provocative testing with acid and edrophonium) and 24-hour esophageal pH monitoring in identifying an esophageal cause of chest pain.
A prospective study of 100 consecutive patients referred by cardiologists to the esophageal laboratory for evaluation of esophageal causes of chest pain.
Tertiary-referral university hospital.
Esophageal manometry performed with 10 wet swallows of water. Acid perfusion (0.1 N hydrochloric acid) and edrophonium (80 micrograms/kg intravenously) tests were placebo-controlled with a positive study defined as replication of typical chest pain. Esophageal pH monitoring identified (1) abnormal acid exposure times in the upright, supine, or combined position, and (2) correlation between symptoms and acid reflux, i.e., symptom index. The esophagus was identified as "probably" contributing to chest pain only if the acid or edrophonium test was positive or if there was a positive correlation between symptoms and acid reflux during pH monitoring.
Esophageal manometry was abnormal in 32 patients (32%), but patients were asymptomatic during the study. The acid perfusion test was positive in 18 of 95 patients (19%), and the edrophonium test was positive in 15 of 78 patients (19%). Abnormal acid exposure times were found in 48 patients (48%). Of the 83 patients with spontaneous chest pain during 24-hour pH testing, 37 patients (46%) had abnormal reflux parameters and 50 patients (60%) had a positive symptom index (mean positive score 56%, range 6% to 100%).
Acid reflux is a common and potentially treatable cause of noncardiac chest pain. Traditional esophageal tests usually miss this diagnosis. Twenty-four-hour esophageal pH monitoring with symptom correlation is the single best test for evaluating patients with noncardiac chest pain.
比较传统食管检查（测压以及用酸和依酚氯铵进行激发试验）和24小时食管pH监测在确定胸痛的食管病因方面的诊断能力。
对100例由心脏病专家转诊至食管实验室以评估胸痛食管病因的连续患者进行的前瞻性研究。
三级转诊大学医院。
通过吞咽10次含水唾液进行食管测压。酸灌注（0.1N盐酸）和依酚氯铵（静脉注射80微克/千克）试验采用安慰剂对照，阳性研究定义为典型胸痛再现。食管pH监测确定（1）直立、仰卧或联合体位时的异常酸暴露时间，以及（2）症状与酸反流之间的相关性，即症状指数。仅当酸或依酚氯铵试验呈阳性，或pH监测期间症状与酸反流呈正相关时，食管才被确定为“可能”导致胸痛。
32例患者（32%）食管测压异常，但研究期间患者无症状。95例患者中有18例（19%）酸灌注试验阳性，78例患者中有15例（19%）依酚氯铵试验阳性。48例患者（48%）发现酸暴露时间异常。在24小时pH测试期间有自发性胸痛的83例患者中，37例患者（46%）反流参数异常，50例患者（60%）症状指数阳性（平均阳性评分56%，范围6%至100%）。
酸反流是非心源性胸痛的常见且可能可治疗的病因。传统食管检查通常会漏诊此诊断。24小时食管pH监测及症状相关性分析是评估非心源性胸痛患者的最佳单项检查。
