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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Fifty-eight patients with angina-like chest pain had esophageal manometric testing. Forty-three had no evidence of coronary artery disease at the time of referral or at subsequent contact; 15 patients were proven to have coronary artery disease. High-amplitude contraction waves were the most frequently found manometric abnormality (15 patients). Less frequent were increased duration of contractions, achalasia, and diffuse esophageal spasm; the latter was present in only 3 patients. An approach to the interpretation of information obtained during manometry is presented. Using this approach, the esophagus was strongly implicated as the cause of the pain in 20 patients and was suspect in 18 others. Seven patients had results that exonerated the esophagus, and in the 13 remaining individuals, the esophagus was probably not the offending organ.
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PMID:Esophageal manometrics in patients with angina-like chest pain. 40 71

During the past ten years 7 men and 15 women with diffuse esophageal spasm have been seen at the Duke University Medical Center. Dysphagia and severe substernal pain were the two characteristic symptoms. Eleven of the 22 patients were treated with a long esophageal myotomy. Two had a diverticulum of the lower esophagus excised in addition, while 6 had an associated sliding hiatal hernia repaired. Three patients in whom the diagnosis was made retrospectively all had an epiphrenic diverticulum excised without a myotomy; in 1 an esophageal leak occurred. These 3 patients still have mild symptoms of their diffuse esophageal spasm. The results of myotomy have been satisfactory. Although this operation does not correct the cause of the disorder, the improvement in symptoms makes it worthwhile in selected patients.
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PMID:Diffuse spasm of the esophagus. 80 72

The study was carried out on 18 patients with angina pectoris in whom the usual treatment with nitroderivatives and/or Ca-antagonists did not improve or prevent the angina-like chest pain in the absence of unstable angina. The patients underwent the following oesophageal examinations: X-ray, endoscopy-biopsy, manometry, acid perfusion test and 24-hour oesophageal pH ambulatory monitoring, the latter two being made in association with dynamic ECG. The presence of coronary insufficiency had been previously determined by means of ECG and scintigraphic stress tests and, when necessary, coronary arteriography was performed. In 10/18 patients severe oesophageal motor disorders were observed, the most frequent being diffuse oesophageal spasm. In the entire group the lower oesophageal sphincter basal tone was significantly lower than normal. In 14/18 patients a pathologic gastroesophageal reflux was detected: in 2 of these patients a temporal correlation between pain attacks and episodes of gastroesophageal reflux were observed in the absence of ECG modifications. Acid perfusion test induced the angina-like chest pain in another 2 patients without ECG modifications. In conclusion, the angina-like chest pain of these patients is not due to a failure of the antianginal therapy in relieving the coronary insufficiency, but is most probably related to gastroesophageal reflux. This oesophageal disorder may be considered a side effect caused by prolonged therapy with nitroderivatives and Ca-antagonists. In fact, these drugs decrease the lower oesophageal sphincter tone which is the main barrier against the reflux of gastric contents into the oesophagus so favoring gastroesophageal reflux and related disorders, including oesophageal pain.
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PMID:"Oesophageal angina" in patients with angina pectoris: a possible side effect of chronic therapy with nitroderivates and Ca-antagonists. 139 24

Esophagomyotomy was performed in 42 patients with chest pain resulting from diffuse esophageal spasm and related disorders. The procedure used restricted the myotomy to the diseased portion of the esophagus, as demonstrated manometrically. More than half of the patients also required myotomy of the lower esophageal sphincter. Some patients required other surgical procedures. Overall results were excellent; the overall improvement rate was 70% at a median follow up of 5 years, 8 months. Postoperatively, 5 patients had recurrent or persistent pain. Esophagomyotomy is recommended for selected patients with clinically significant chest pain and/or dysphagia.
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PMID:Esophagomyotomy for noncardiac chest pain resulting from diffuse esophageal spasm and related disorders. 159 58

Calcium antagonist relax smooth muscle, a possible useful concept in treatment of diffuse oesophageal spasm. Therefore the effects of oral diltiazem (60 mg t.d.s.) and placebo were compared in eight patients with diffuse oesophageal spasm in a 10-week double-blind crossover study. The patients recorded the severity of chest pain and/or dysphagia in daily pain diaries using visual analogue scales. Chest pain index and dysphagia index were calculated by multiplying frequency with daily intensity of each individual symptom. When compared to placebo, diltiazem did not significantly change the overall dysphagia index and chest pain index. An individual sizeable reduction of dysphagia was attained on diltiazem in four out of six patients and in six out of eight patients suffering from chestpain. Side effects were not seen during diltiazem therapy. Diltiazem, in our study, did not yield in a significant improvement of symptoms in diffuse oesophageal spasm. Diltiazem, however, can offer relief in selected individual patients suffering from diffuse oesophageal spasm.
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PMID:Efficacy of diltiazem in the treatment of diffuse oesophageal spasm. 210 59

Esophageal motility disorders are now known to be a heterogeneous group of conditions that commonly cause dysphagia and chest pain. Motor dysphagia is usually provoked by solids and liquids (in contrast to mechanical dysphagia, which is usually provoked by solids only). Chest pain with these disorders is nonspecific and can mimic angina pectoris. In many patients with diffuse esophageal spasm or nutcracker esophagus, pain appears to be caused by abnormal sensory function rather than contraction abnormalities. Barium esophagography and esophageal manometry are complementary studies in the evaluation of motility disorders.
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PMID:Diagnosis of esophageal motility disorders. 239 4

The three main symptoms of esophageal disease or disorder are dysphagia, chest pain, and heartburn. Dysphagia in achalasia is mainly due to a non-relaxing lower esophageal sphincter (LES). The mechanism of dysphagia in diffuse esophageal spasm and related motor disorders is related to a combination of several factors including incomplete LES relaxation, failed or weak peristalsis (pressure less than 30 mmHg in the distal esophagus, and orad positive pressure gradient). Meal manometry and balloon distention may prove to be useful provocation tests. Chest pain of esophageal origin may be due to gastroesophageal reflux and esophageal motility disorders; it may also be a manifestation of an irritable esophagus, in which the esophagus is hypersensitive to various stimuli (chemical, mechanical, ischemic). Esophageal provocation tests may suggest the esophageal origin of the pain but do not give information on the nature of the esophageal disorder. Twenty-four-hour pH and pressure measurements may, however, yield this information. Heartburn and acid regurgitations are the most typical symptoms of gastroesophageal reflux. Transient relaxations of the LES are considered to be an important contributory mechanism of reflux. Absent basal LES pressure is another mechanism, which accounts for about one-fourth of the reflux episodes in patients with severe reflux esophagitis. During long-lasting inappropriate relaxations, swallows often produce deglutitive contraction waves that die out in the upper esophagus, suggesting that reflux often occurs during periods of inhibition of both LES tone and peristaltic esophageal activity.
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PMID:Recent studies of the pathophysiology and diagnosis of esophageal symptoms. 223 80

The term "atypical chest pain" is a waste-basket term that leads physicians to send any patient with chest pain to coronary angiography. In order to avoid this term, we must learn to distinguish atypical angina from nonanginal chest pain before angiography is considered in order to avoid unnecessary invasive procedures. A chest pain is very likely nonanginal if its duration is over 30 minutes or less than 5 seconds, it increases with inspiration, can be brought on with one movement of the trunk or arm, can be brought on by local fingers pressure, or bending forward, or it can be relieved immediately on lying down. There are also many presumptive signs of nonanginal chest pain such as localization with one finger, radiation to the nuchal area, an inframammary primary site, a pain that reaches maximum at the onset, or relief within a few seconds of swallowing food. Cervical root compression pain and esophageal spasm are the greatest mimics of angina since they can both be relieved by nitroglycerin but they have several features which help to rule out angina.
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PMID:The diagnosis of nonanginal chest pain. 225 29

Ambulatory 24-hour esophageal manometry was applied to analyze motility in 12 normal subjects and 9 patients with chest pain and dysphagia caused by diffuse esophageal spasm (DES). Pain episodes characterized by nonperistaltic activity occurred in 7 of 9 patients. A score based on 10 variables of the motility pattern differentiated patients from normal subjects and quantitated the severity of the disorder. Ambulatory motility monitoring was prospectively performed in 8 normal subjects and 37 patients: 8 with DES, 13 with hypertensive contractions, and 16 with a nonspecific disorder on standard manometry. The score was positive in 6 of 8 patients with DES and negative in all normal subjects (accuracy 87 percent). Nine of the 13 patients with hypertensive contractions (70 percent) and 6 of 16 with nonspecific disorders (38 percent) had a pathologic score reflecting a dysmotility as severe as DES. Ambulatory esophageal manometry is a more physiologic way to identify a motor disorder than standard manometry and has the potential to improve selection of patients for a surgical myotomy.
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PMID:A new technique to define and clarify esophageal motor disorders. 229 91

Five adolescents, 13-18 years of age, underwent esophageal manometric studies because of chronic symptoms suggestive of esophageal dysfunction. Four of five patients had episodic nonexertional midchest pain; two patients experienced intermittent dysphagia. The manometric findings for these adolescents were consistent with a primary motility disorder known as diffuse esophageal spasm, a condition not previously reported in this age group. This represents approximately 1% of all pediatric patients undergoing esophageal manometry at our institution for the past 5 years. They have been followed for at least 2 years and three have experienced gradual resolution of their symptoms with normalization of manometric findings. Our report emphasizes two main points: (a) Diffuse esophageal spasm may cause chest pain and dysphagia in adolescents; and (b) the clinical history and esophageal manometric findings establish the diagnosis of diffuse esophageal spasm.
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PMID:Chest pain and dysphagia in adolescents caused by diffuse esophageal spasm. 262 23


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