Esophageal motility disorders may be an important cause of noncardiac
chest pain. To improve our diagnostic yield, we studied the use of
edrophonium as a provocative test for inducing esophageal
chest pain in 50 symptomatic patients without
coronary artery disease and in 25 age-matched controls.
Edrophonium (80 micrograms/kg of
body weight, intravenous bolus) induced
chest pain in 15 (30%) patients and in no controls.
Edrophonium increased esophageal amplitude and repetitive contractions to a similar degree in all subjects, but the change in duration (101 +/- 13% [SE] was significantly greater (p less than 0.02) in patients in whom
chest pain was induced.
Drug specificity was assessed in 9 patients during cardiac catheterization, but no significant change was seen in coronary artery diameter, blood pressure, or heart rate. Further clinical testing using a placebo control confirmed a positivity rate of 28% in 125 unselected patients with
chest pain referred to our laboratory; false-positive tests were infrequent (5.6%). No important side effects were seen.
Edrophonium is useful for provoking esophageal
chest pain.