Abstract
The charts of 83 children with chest pain who underwent esophageal manometry followed by esophagogastroscopy were reviewed. Forty-seven (57%) had normal esophageal histology and normal motility (group I). Esophagitis and normal motility were demonstrated in 15 children (group II), normal esophageal histology and esophageal dysmotility in 13 (group III), and both esophagitis and abnormal motility in 8 (group IV). Diffuse esophageal spasm and achalasia were the most common motility disorders identified (in seven and four patients, respectively). The presence and duration of symptoms, the age, and the gender were not different among the four patient groups. After six months of H2-receptor blockade, 12 of 15 group II patients were asymptomatic, whereas a significantly smaller percentage (five of 18) of patients with abnormal esophageal motility responded to esophageal dilation or treatment with calcium channel blockade, H2-receptor antagonist, and/or prokinetic agents (P<0.01). These data suggest that the evaluation of children with chest pain should include esophageal motility testing and esophagoscopy, even in the absence of other gastrointestinal-associated symptoms, and that while treatment of esophagitis results in resolution of symptoms, motility disorders were relatively refractory to therapy.
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McCallum RW: The spectrum of esophageal motility disorders. Hosp Pract 22:71–83, 1987
DeMeester TR, O'Sullivan GC, Bermudez G, Midell AI, Cimochowski G, O'Drobinak J: Esophageal function in patients with angina-type chest pain and normal coronary angiograms. Ann Surg 196:488–498, 1982
Richter JE, Bradley LA, Castell DO: Esophageal chest pain: Current controversies in pathogenesis, diagnosis and therapy. Ann Intern Med 110:66–78, 1989
Peters L, Maas L, Petty D, Dalton C, Penner D, Wu WC, Castell DO, Richter J: Spontaneous noncardiac chest pain: Evaluation by 24-hour ambulatory esophageal motility and pH monitoring. Gastroenterology 94:878–886, 1988
Breumelhof R, Nadorp JHSM, Akkermans LAM, Smout AJP: Analysis of 24-hour esophageal pressure and pH data in unselected patients with noncardiac chest pain. Gastroenterology 99:1257–1264, 1990
Benjamin SB, Richter JE, Cordova CM, Knuff TE, Castell DO: Prospective manometric evaluation with pharmacologic provocation of patients with suspected esophageal motility dysfunction. Gastroenterology 84:893–901, 1983
Selbst SM, Ruddy RM, Clark BJ, Henredig FM, Santulli T Jr: Pediatric chest pain: A prospective study. Pediatrics 82:319–323, 1988
Brenner JI, Ringel RE, Berman MA: Cardiologic perspectives of chest pain in childhood: a referral Problem? Pediatr Clin North Am 31:1241–1258, 1984
Berezin S, Medow MS, Glassman MS, Newman LJ: Chest pain of esophageal origin. Arch Dis Child 63:1457–1460, 1988
Richter JE, Wu WC, Johns DN, Blackwell JN, Newson JL, Castell JA, Castell DO: Esophageal manometry in 95 healthy adult volunteers: Variability of pressure with age and frequency of abnormal contractions. Dig Dis Sci 32:583–592, 1987
Castell DO, Richter JE, Dalton CB, (eds). Esophageal Motility Testing. New York, Elsevier, 1987
Behar J, Sheahan DC: Histologic abnormalities in reflux esophagitis. Arch Pathol 99:387–391, 1975
Woolf PK, Gewitz MH, Berezin S, Medow MS, Stewart JM, Fish BG, Glassman MS, Newman LJ: Noncardiac chest pain in adolescents and children with mitral valve prolapse. J Adolesc Health Care 12:1–4, 1991
Berezin S, Medow MS, Glassman MS, Newman LJ: Esophageal chest pain in children with asthma. J Pediatr Gastroenterol Nutr 12:52–55, 1991
Katz PO, Dalton CB, Richter JE, Wu WC, Castell DO: Esophageal testing of patients with noncardiac chest pain or dysphagia: Results of three years' experience with 1161 patients. Ann Intern Med 106:593–597, 1987
Janssens J, Vantrappen G, Ghillebert G: 24-hour recording of esophageal pressure and pH in patients with noncardiac chest pain. Gastroenterology 90:1978–1984, 1986
Boyle JT, Cohen S, Watkins JB: Successful treatment of achalasia in childhood by pneumatic dilation. J Pediatr 99:35–40, 1981
Berquist WE, Byrne WJ, Ament ME, Fonkalsrud EW, Euler AR: Achalasia: Diagnosis, management and clinical course in 16 children. Pediatrics 71:798–805, 1983
Maksimak M, Perlmutter DH, Winter HS: The use of nifedipine for the treatment of achalasia in children. J Pediatr Gastroenterol Nutr 5:883–886, 1986
Milov DE, Cynamon HA, Andres JM: Chest pain and dysphagia in adolescents caused by diffuse esophageal spasm. J Pediatr Gastroenterol Nutr 9:450–453, 1989
Brunswick AP, Bovie JM, Tanca C: Who sees the doctor? A study of urban black adolescents. Soc Sci Med 13A:45–46, 1979
Brown RT: Chostochondritis in adolescents. J Adolesc Health Care 1:198–201, 1981
Fife DA, Moodie DS: Chest pain in pediatric patients presenting to the cardiac clinic. Clin Pediatr 23:321–324, 1984
Selbst SM: Chest pain in children. Pediatrics 75:1068–1070, 1985
Pantell RH, Goodman BW Jr: Adolescent chest pain: A prospective study. Pediatrics 71:881–887, 1983
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Glassman, M.S., Medow, M.S., Berezin, S. et al. Spectrum of esophageal disorders in children with chest pain. Digest Dis Sci 37, 663–666 (1992). https://doi.org/10.1007/BF01296420
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DOI: https://doi.org/10.1007/BF01296420