To the Editor.
—Spears et al1 report that esophageal dysmotility was found in 78% of their patients with mitral valve prolapse (MVP), associated with chest pain and normal coronary arteries. A similar association was previously described,2 and since this initial brief report, esophageal studies performed in four other patients with MVP and chest pain corroborate the findings of Spears and his colleagues.I am impressed by the high incidence of the irritable bowel syndrome (IBS) in patients who also have MVP. Many of the clinical features of the two entities are similar, eg, the female preponderance, and the frequent episodes of symptoms such as weakness, anxiety, and panic attacks. An increased incidence of esophageal motility disorders has been reported in patients with psychiatric illnesses.3 A neurohormonal imbalance might account for the symptomatology of both MVP and IBS, as each is characterized by a "dysrhythmia"; MVP, the