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January 25, 1980

Chest Pain

JAMA. 1980;243(4):332. doi:10.1001/jama.1980.03300300014014

To the Editor.—  In response to a question concerning anginal pain in diabetics with normal coronary arteriography (241:2311, 1979) Samuel Zoneraich, MD, discusses the pain resulting from small-vessel disease of the myocardium.We would like to suggest that esophageal spasm may also produce "typical angina," which often responds to nitroglycerin.1,2 Motor disorders of the esophagus in diabetics are well known,3,4 and spasm secondary to reflux esophagitis,5 moniliasis (Sheft DJ, Shrago G: JAMA 213:1859-1862, 1970), and other conditions may initiate and/or aggravate the pain.The acid perfusion (Bernstein) test, esophageal manometry, and endoscopy may be helpful in establishing the cause of chest pain in any patient without overt coronary artery disease.