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November 12, 1982

Chest Pain: Heart? Gullet? Both? Neither?

Author Affiliations

Veterans Administration Medical Center Seattle

JAMA. 1982;248(18):2315. doi:10.1001/jama.1982.03330180075042

Crushing substernal chest pain usually convinces the patient that death from heart disease is near, and provokes the physician to invoke the services (and expenses) of coronary care units, coronary angiography, and even coronary bypass surgery. Yet, as the article by Dr Alban Davies and his colleagues (p 2274) reemphasizes, the gullet may be the offending organ in as many as one fifth of patients who come to a general hospital emergency room with chest pain. The authors demonstrated that eight of the 77 patients complaining of angina pectoris were shown to have bouts of chest pain that correlated closely either with acid perfusion of the esophagus or esophageal motor abnormalities detected manometrically. Another eight patients were shown to have esophageal abnormalities on testing, but these abnormalities were not associated with pain.

This latter observation is the nub of the problem when esophageal testing is used to sort out persons