Detection of abnormal esophageal motility and gastroesophageal reflux in patients with angina-like chest pain by a radionuclide esophageal transit test.

A modified radionuclide esophageal transit test including the esophageal mean transit time (MTT), residual fraction (RF) and retrograde index (RI), was carried out to evaluate esophageal motility and to detect gastroesophageal reflux in three groups: (A) 25 patients (13 males, 12 females, age: 45-65 years) with angina-like chest pain but normal coronary angiogram; (B) 31 patients (14 males, 17 females, age: 42-63 years) with coronary artery disease (CAD) demonstrated by abnormal coronary angiographic findings and intractable angina-like chest pain even after treatment; and (C) 25 normal volunteers (10 males, 15 females, age: 39-67 years). In groups A and B abnormal results were found in 60% (15/25) and 39% (12/31) for MTT; in 28% (7/25) and 39% (12/31) for RF and in 36% (9/25) and 58% (18/31) for RI (i.e., higher than the mean +/- 2 SD of normal values; MTT: 5.72 +/- SD 0.91, RF: 0.129 +/- SD 0.057, RI: 0.055 +/- SD 0.054), respectively. We conclude that the causes of non-cardiac chest pain in group A patients with normal coronary arteries were primarily esophageal dysmotility or spasm (prolonged MTT). However, in group B patients decreased pressure of the lower esophageal sphincter due to the side effects of anti-angina drugs induced delayed cleaning of the esophagus (higher RF) or gastroesophageal reflux (higher RI).