Exertional gastroesophageal pH-metry: a new provocative physiological test in the diagnosis of chest pain.

With the aim of determining the value of physical exercise as a provocative test for chest pain associated with gastroesophageal reflux, 67 patients presenting non-cardiac chest pain (normal coronary angiograms and no functional coronary artery alterations) with different characteristics (group A: at rest; group B: exertional or mixed-type) underwent exercise tests during 24-hour gastroesophageal pH-metry associated with electrocardiographic (EKG) monitoring. Thirty-four patients in group A (73.4%), and 12 in group B (57%) showed pathological reflux on 24-hour gastroesophageal pH-metry. Twelve patients in group A (25%) and 6 in group B (28.5%) (total ratio: 26.8%) presented positive responses to exercise, with concomitant occurrence of gastroesophageal reflux, typical pain, without EKG ischemic signals. Exertional pH-metry allowed to reach diagnostic certitude in 10 (14.9%) of 67 patients, 9 presenting 24-hour pH-metry results that only suggested "possible" diagnosis, and 1 without either pathological reflux or pain during prolonged monitoring: all these patients belonged to group A. The repetition of the test showed total reproducibility of the results, with "fixed thresholds" of exercise in 11 of 18 subjects (61.1%). These data suggest the usefulness of grouping different diagnostics (24-hour EKG, pH-metry and exertional test) to increase diagnostic certitude, mainly in patients with primary angina. Exertional pH-metry shows to be an efficacious provocative test, and the only based on a physiological stimulus.