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Oesophageal pain threshold (OEPT) can be determined by
delivering in the third inferior of oesophagus electrical stimuli of 10 ms duration and
progressive intensity. In previous work, OEPT values, expressed in milliampere (mA),
resulted significantly different between syndrome X (7 ± 2 mA), effort angina (16 ± 5
mA), oesophageal disease (8 ± 2 mA), and control group (22 ± 4 mA) patients. The aim of
this study was to investigate the clinical value and diagnostic accuracy of new technique
on the assessment of chest pain in patients that do not have clear evidence of cardiac
ischemic pain. The new technique is involved in the assessment of oesophageal pain
threshold by electrical oesophageal stimulation. Furthermore, the same oesophageal
catheter has been used to achieve stress echocardiography by performing a
trans-oesophageal cardiac pacing. In 45 consecutive patients with atypical chest pain,
OEPT values resulted normal in 6 and low in 39 patients. The evoked symptoms at OEPT and
basal heart rate were reproducible in each patient. In 16 patients, the evoked symptoms
were equal to spontaneous symptoms and defined "clinical pain", in 29 patients
were dissimilar and defined "non clinical pain". Very low OEPT values (< 10
mA) were present in 37 patients with oesophageal disease. Cardiac overpacing was effective
in 41 patients and determined left ventricular wall motion abnormalities in 10 patients (3
with non clinical pain); coronary insufficiency was confirmed in the same segment of
diskinesia and treated successfully with PTCA. Oesophageal palpitations and/or dyspnoea,
associated with chest pain, disappeared after complete removal of gastro-oesophageal
reflux of acid. In conclusion, the assessment of electrical oesophageal pain threshold,
combined with echocardiographic stress testing, is very effective as diagnostic tool,
simple to perform and does not require expensive equipment.
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