Esophageal origin of precordial pain in chagasic patients with normal subepicardial coronary arteries

To study the chest pain of esophageal origin in chagasic patients (CH) and non-chagasic subjects (NCH) with normal coronary arteries. The study comprised 48 patients: 33 CH (age 56 years, 50% male) and 15 NCH (age 47 years, 25 male), with precordial chest pain and normal subepicardial coronary arteries. They were assigned to upper digestive tract radiologic and endoscopic study, esophageal manometric evaluation at baseline and after provocative tests (Bernstein and intravenous edrophonium). Radiologic study: 14 (42%) CH and 4 (27%) NCH had esophageal dilation (p > 0.05). Hiatal hernia was documented in 7 (21%) CH and 6 (40%) NCH (p > 0.05). 2) Digestive endoscopy: In 15 (45%) CH and 6 (40%) NCH distal esophagitis were seen. In the NCH, esophagitis occurred with hiatal hernia; however only 30% of CH with esophagitis had also hiatal hernia while another 30% had esophageal dilation. 3) Esophageal motility disorders (EMD): 11 (33%) CH showed EMD: 8 with inferior esophageal sphincter achalasia (IESA) and 3 with diffuse esophageal spasm. Among NCH, 2 (13%) had IESA (p > 0.05). 4) Bernstein test--a positive test was seen in 5 (15%) CH and 3 (20%) NCH-p > 0.05. CH with esophageal dilation had 14% of positive results, while CH without esophageal dilation had 16%-p > 0.05. 5) Intravenous edrophonium-esophageal contraction amplitude enhancement provoked by the drug infusion was clearly attenuated in the chagasic (6.9 +/- 12.7 mmHg) when compared with the NCH group (18.8 +/- 21.4 mmHg). A positive test (i.e. chest pain) was obtained in only one patient who was NCH. Esophageal pain could be elicited at a relatively low and comparable rate in both groups of patients.