The Value of the Esophageal Motility Test in the Evaluation of Thoracic Pain Problems

Abstract

This study was made to determine the value of the esophageal motility test as a diagnostic procedure in cases of thoracic pain. A review was made of the records of 514 patients undergoing studies of esophageal motility at the Mayo Clinic from May, 1957, through April, 1959. From these varied clinical cases, 45 patients with a diagnostic problem of pain in the thorax were found in whom a definitive diagnosis had not been established by means other than the motility test. These 45 patients were found to form four main groups: (1) eight patients without objective evidence of either myocardial ischemia or esophageal motility abnormalities; (2) two patients with objective evidence of myocardial ischemia, but no abnormalities of esophageal motility records; (3) 17 with abnormalities of the esophageal motility records, but no objective evidence of ischemic myocardial disease, and (4) 18 patients with evidence of both abnormal esophageal motility and myocardial ischemia. The abnormal esophageal motility findings in these patients included, in order of frequency, the patterns for diffuse spasm, hiatal hernia, the hypertensive and the hyperreacting gastroesophageal sphincter. Various combinations of these motility disorders were often found in the same patient. The incidence of hypertensive gastroesophageal sphincter was exceedingly high. Clinical differentiation could not be made consistently between the pain of ischemic heart disease and that of esophageal motility disorders. It is recommended that when patients present a diagnostic problem related to pain in the thorax, ischemic heart disease should be excluded even though the presence of esophageal disorders is proved. The electrocardiogram after exercise may be helpful in the evaluation of such patients.