JOEL E. RICHTER, M.D.; BARRY T. HACKSHAW, M.D.; WALLACE C. WU, M.B., B.S.; DONALD O. CASTELL, M.D.
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 µg/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 < 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.
RICHTER JE, HACKSHAW BT, WU WC, et al. Edrophonium: A Useful Provocative Test for Esophageal Chest Pain. Ann Intern Med. 1985;103:14–21. doi: 10.7326/0003-4819-103-1-14
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Published: Ann Intern Med. 1985;103(1):14-21.
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