Unexplained Noncardiac Chest Pain
Authors: Satish S.C. Rao
Journal: Annals of Internal Medicine (1997)

Letters15 April 1997Unexplained Noncardiac Chest PainSatish S.C. Rao, MD, PhD, Robert W. Summers, MD, and Hans Gregersen, MDSatish S.C. Rao, MD, PhDThe University of Iowa, Iowa City, IA 52242University of California, San Diego, San Diego, CA 92093-0404Search for more papers by this author, Robert W. Summers, MDThe University of Iowa, Iowa City, IA 52242University of California, San Diego, San Diego, CA 92093-0404Search for more papers by this author, and Hans Gregersen, MDThe University of Iowa, Iowa City, IA 52242University of California, San Diego, San Diego, CA 92093-0404Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-126-8-199704150-00025 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:Dr. Fass raises several issues. The first is that local anesthesia should be avoided. We agree, in reality, that it is not possible to place a manometric probe through the mouth without pharyngeal anesthesia. However, we took precautions to avoid dispersion of local anesthetic downstream and did graded balloon distentions 30 to 45 minutes after probe placement, negating any possible influence of anesthetic on esophageal perception. The second issue is whether incremental distention using variable volumes is better than variable pressure. As discussed previously [1, 2], balloon distention with varying volume has a poor predictive value. Esophageal sensation ...References1. Rao SS, Hayek B, Summers RW. Impedance planimetry: an integrated approach for assessing sensory, active and passive biomechanical properties of the esophagus. Am J Gastroenterol. 1995; 90:431-8. Google Scholar2. Rao SS, Patel RS, Hayek B, Summers RW. Is the level at which a balloon is distended important in the evaluation of esophageal chest pain? [Abstract] Gastroenterology. 1996; 110:A742. Google Scholar3. Patel RS, Rao SS. Biomechanical and sensory parameters of the human esophagus vary with age [Abstract]. Am J Gastroenterol. 1995; 90:A1567. Google Scholar4. Goyal RK. Changing focus on unexplained esophageal chest pain [Editorial]. Ann Intern Med. 1996; 124:1008-11. Google Scholar5. Cannon RO 3d, Quiyyumi AA, Mincemoyer R, Stine AM, Gracely RH, Smith WB, et al. Imipramine in patients with chest pain despite normal coronary angiograms. N Engl J Med. 1994; 330:1411-7. Google Scholar Author, Article, and Disclosure InformationAuthors: Satish S.C. Rao, MD, PhD; Robert W. Summers, MD; Hans Gregersen, MDAffiliations: The University of Iowa, Iowa City, IA 52242University of California, San Diego, San Diego, CA 92093-0404 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 15 April 1997Volume 126, Issue 8Page: 663-664KeywordsAnesthesiaAnestheticsEmergency departmentEsophagusHypersensitivityIschemiaMouthPanic disorderPerceptionStable coronary artery disease ePublished: 15 August 2000 Issue Published: 15 April 1997 Copyright & PermissionsCopyright © 1997 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...