Exertional gastroesophageal pH-metry: a new provocative physiological test in the diagnosis of chest pain
Bovero, E.; Torre, F.; Poletti, M.; Faveto, M.; De Iaco, F.
Gastroenterologie Clinique et Biologique 17(1): 4-8
1993
ISSN/ISBN: 0399-8320 PMID: 8467970 Document Number: 407424
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 mchlt possible mchgt 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 mchlt fixed thresholds mchgt 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.