[Nitroglycerin and angina with angiographically normal coronary vessels. Clinical effects and effects on esophageal motility].

In order to determine whether the presence of a retrosternal pain sensitive to nitroglycerin is predictive of the finding of esophageal dyskinesia in patients with normal coronary angiography and negative methylergonovine test, we administered 0.8 mg of a nitroglycerin spray during esophageal manometry and after a methylergonovine or edrophonium provocation test. The effects of nitroglycerin on esophageal motility were recorded and compared with clinical data. Forty patients (21 men, 19 women, mean age 54 +/- 8 years) entered the study. In 22 of them (55 p. 100) the retrosternal pain was relieved by nitroglycerin within less than 5 minutes; the provocation test was positive in 10 cases (25 p. 100). In all patients nitroglycerin produced a highly significant decrease in the duration and amplitude of esophageal contractions. Among the 10 patients with esophageal dyskinesia, the duration of contractions was significantly more reduced (p less than 0.005) in those with nitroglycerin-sensitive pain (6 patients) than in those with nitroglycerin-resistant pain. These 6 patients, therefore, could be regarded clinically and manometrically as "responders" to nitroglycerin. Two of them had gastro-esophageal reflux. In contrast, among patients without induced esophageal dyskinesia the effects of nitroglycerin on manometry were the same irrespective of whether or not pain was usually relieved by nitroglycerin. The fact that pain was nitroglycerin-sensitive had no predictive value concerning the finding of esophageal dyskinesia by the provocation test (non-significant X2 test). We conclude that the clinical and manometric effects of nitroglycerin were concordant only in patients with induced esophageal dyskinesia; patients who responded to nitroglycerin could have a gastro-esophageal reflux.(ABSTRACT TRUNCATED AT 250 WORDS)