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Increased Esophageal Wall Thickness in Patients with Non-Cardiac Chest Pain

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Al-Haddad, Mohammad MD; Raimondo, Massimo MD; Wallace, Michael B. MD; Woodward, Timothy A. MD; Pungpapong, Surakit MD; Devault, Kenneth R. MD; Ward, Eric M. MD; Achem, Sami R. MD

American Journal of Gastroenterology: September 2006 - Volume 101 - Issue - p S70
Abstracts: ESOPHAGUS
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Gastroenterology, Mayo Clinic College of Medicine, Jacksonville, FL.

Purpose: Noncardiac chest pain (NCCP) is a common and challenging clinical problem. The pathogenesis of chest pain is multi-factorial and not well understood. A stiff, less distensible esophagus has been identified in these patients using impedance planimetry.

Hypothesis: The impaired elasticity of the esophageal wall in NCCP is due to a structural defect-i.e. enhanced esophageal wall thickness.

Aims: Evaluate the esophageal wall diameter of patients with NCCP in comparison to controls using standard radial endoscopic ultrasound (EUS).

Methods: Consecutive patients with NCCP referred for upper endoscopy to exclude gastrointestinal mucosal sources of chest pain were invited to have EUS of the esophagus at the same session. Following completion of upper endoscopy, patients with a negative mucosal exam underwent EUS evaluation of the esophageal wall. The entire esophageal wall was evaluated using the Olympus radial echoendoscope (GF UM 130 and GF-UE 160). Measurements of the esophagus were obtained at approximately 2–3 cm from the squamous columnar junction (SCJ) (distal), 8 cm from the SCJ (middle), and 2–3 cm below the UES (proximal). Control subjects were consecutive patients undergoing EUS for other indications but without esophageal symptoms and with a normal esophageal mucosa exam during EGD. Statistical analysis was done by Wilcoxon rank-sum and Fisher's exact test.

Results: 79 patients were studied (35 consecutive patients with NCCP and 44 controls). See table 1.

Table

Table

Conclusions: Patients with NCCP have an increased esophageal wall thickness- as demonstrated by EUS. Since EUS is readily available and can be performed in conjunction with EGD, the identification of this structural defect may serve as a morphologic marker to study patients with NCCP.

© The American College of Gastroenterology 2006. All Rights Reserved.