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Questioning the Value of Esophageal Motility Testing in Chest Pain of Noncardiac Origin-Reply

Sarkis J. Chobanian, MD
Arch Intern Med. 1987;147(2):212. doi:10.1001/archinte.1987.00370020032024.
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I believe the comments of Engel and Lawrence beg the question of whether or not we proved the utility of an esophageal evaluation in patients with noncardiac chest pain. Our purpose was to provide evidence for the clinician that anginalike chest pain severe enough to warrant admission to a cardiology service merits evaluation once cardiovascular disease has been excluded. Such an evaluation should include tests directed at identifying disorders of esophageal structure and function since this organ has been implicated in numerous studies of similar design. Engel and Lawrence are correct in stating that to prove causality requires more; but I am sure these gentlemen know that the necessary technology (a Holter-like, ambulatory manometry system) is only now becoming available for investigators.1 Succinctly written, the overwhelming bulk of evidence supports the contention that a wide array of esophageal disorders (dysmotility, spasm, and reflux) are found in patients with anginalike


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