비심인성 흉통환자에서 식도운동검사의 의의

송치욱(Chi Wook song),구양서(Yang Suh Koo),이홍식(Hong Sik Lee),이상우(Sang Woo Lee),최재현(Jai Hyun Choi),김창덕(Chang Duck Kim),류호상(Ho Sang Ryu),현진해(Jin Hai Hyum) 대한소화기학회 1995 대한소화기학회지 Vol.27 No.4

N/A Background/Aims: Recently the esophagus is considered a major source of recurrent noncardiac chest pain to patients in whom exercise stress test and/or cardiac catheterization have excluded a cardiac etiology. To investigate the esophageal origin of noncardiac chest pain, esophageal motility tests including manometry, provocation test, and radioisotope esophahgeal transit study(RETS) were studied in patients with noncardiac chest pain. Methods: A total of l26 patients with noncardiac chest pain were assessed;they included 41 patients with normal coronary angiogram and 85 patients with normal noninvasive cardiac tests such as echocardiogram and exercise stress test done in Korea University Hospital from Feb. l993 to Aug. 1994. Results: 56 out of 126 patients(44.4%) with noncardiac chest pain had abnormal manometric findings which included 20(35.7%) nonspecific esophageal motility disorder, 17(30.4%) hypertensive lower esophageal sphincter, 9(16.1%) hypo- tensive lower esophageal sphincter, and 2(3.6%) nutcracker esophagus. Thirty eight out of 126(30.1 %) patients had abnormal manometric findings but no reproducible chest pain by provocation test and were considered to have a probable esophageal chest pain. When patients having positives for both provocation tests are counted as a single positive, 39 out of l26(3l /o) patients had their chest pain reproduced and were considered to have a defini(e esophageal chest pain. The combination of patients with definite esophageal chest pain(31%) and probable(30.17c) gave an overall diagnostic yield of 61.1% for our esophageal laboratory. There was no significant difference between invasive cardiac test group and noninvasive cardiac test group in the results of esophageal motility tests. RETS merely reflected the peristaltic abnonnalities with no more informations for esophageal chest pain. Conclusions: These results reveal that esophagus is considered a source of noncardiac chest pain in 61.1%. Provocation test complements esophageal manometry alone and increases diagnostic yield. RETS can be used in diagnosis of noncardiac chest pain accompanied by peristaltic abnormality of the esophagus. (Korean J Gastroenterol 1995;27:381-387)

소아 흉통의 원인질환에 따른 임상양상

장국찬,김은영,노영일,양은석,문경래,박영봉 朝鮮大學校 附設 醫學硏究所 2008 The Medical Journal of Chosun University Vol.33 No.2

목적: 소아에서의 흉통은 흔히 접하게 되며 일반적으로 좋은 경과를 보인다. 가장 흔한 원인으로 특발성, 골격계이상, 위장관계 질환 등이 다양하게 언급되고 있으며 감별진단이 쉽지 않아 여러 검사를 시행하게 된다. 자세한 병력청취와 진찰이 진단에 가장 중요하다고 하지만 통계적 의의를 보고한 바는 드물다. 이에 흉통 원인을 분류하고 각각의 임상양상을 파악하여, 병력 청취와 진찰소견의 감별진단에 대한 유용성과 시행 검사들의 의의를 알아보고자 하였다. 방법: 2004년 3월 부터 2007년 8월 까지 조선대학교 병원 소아청소년과에 흉통을 주소로 방문한 환아 77명을 대상으로 하였다. 연령, 성별, 흉통의 위치, 지속시간, 양상, 빈도, 방문까지 걸린 시간, 동반증상, 유발인자의 각 항목과 원인 질환과의 관련성을 분석하였다. 흉부방사선, 심전도, 심초음파, 24시간 Holter, 운동부하 심전도, 상부 위장관 조영술, 24시간 pH 검사, 위내시경, 심근효소를 검사 하였다. 결과: 평균 나이는 10.2±2.8세로 6세에서 11세까지가 48명(62.3%)으로 가장 많은 분포를 보였고 남아 42명(54.5%), 여아 35명(45.5%)이었다. 흉통의 위치는 좌측이 32명(41.6%), 양상은 콕콕 찌르는 것이 27명(35.1%)으로 가장 많았고 지속시간은 1분미만이 36명(46.8%), 1-5분 사이가 28명(36.4%)으로 대부분 5분 미만이었다. 흉통 원인은 특발성이 27례(35.1%)로 가장 많았고, 위장관 질환 23례(29.9%), 늑골 연골염 12례(15.6%), 심혈관 질환 7례(9.1%), 정신신체화 질환 6례(7.8%), 폐질환 2례(2.6%)였다. 여아에서 연령이 높을수록 정신신체화 질환의 빈도가 높았다(P= 0.046). 흉골 하부 통증을 호소한 17명 중 13명(76.5%)이 위장관 질환으로 통계적으로 유의하였다(P= 0.023). 정신 신체화 질환은 6명에서, 위장관 질환도 20명(86.9%)에서 흉통지속시간이 5분 미만이었으나 통계적 의의는 없었다. 흉통 양상 중 타는 듯한 양상을 호소한 7명중 6명에서 위장관 질환이 원인이었으나 통계적 의의는 없었다. 선택 시행 검사 중 심초음파는 32명중 3례(9.4%), 24시간 Holter 검사는 13명중 5례(35.7%), 24시간 pH 검사는 28명 중 16례(57.1%)에서 이상소견을 보였다. 결론: 소아 흉통 환자 중 연령이 높은 여아에서는 정신 신체화 장애를, 흉골 하부 통증을 호소한 경우는 위장관 질환을 먼저 생각하는 것이 좋다고 판단된다. 흉통원인으로 위장관 질환의 빈도가 높고 시행검사들의 진단율을 볼때, 소아 흉통 환아 에서는 상부 위장관 조영술 등 위장관 질환의 검사를 기본적으로 시행하는 것이 좋을 것으로 생각된다. Purpose: Chest pain in children is usually benign. Chest pain in children results from a wide variety of causes. Differential diagnosis of causes is not easy and then many diagnostic approach is trying. Careful history and physical exams must guide the assessment of children with chest pain. The purpose of this study intends to evaluate children with chest pain and usefulness of careful history, physical examination and several diagnostic examinations. Methods: From March 2004 to August 2007, 77 patients presented with chest pain were enrolled. we evaluated age, sex, characteristics of chest pain (location, duration, description, frequency), accompanying symptoms, increasing reasons and relationship with cause of chest pain. Chest x-ray and ECG were checked in all patients. Cardiologic and gastrointestinal evaluations were checked when considered necessary. Results: The male and female ratio was 0.55:0.45, mean age 10.2 ± 2.8 year. Common ages of chest pain were 10 to 12 years old (38case, 49.3%). The location was on the left precordium in 32cases (41.6%) of the patients. The most common diagnostic findings of chest pain were idiopathic(27cases, 35.1%), gastrointestinal disorder (23cases, 29.9%), costo chondritis (12cases, 15.6%), cardiovascular disorder (7cases, 9.1%), psychosomatic disorder(6cases, 7.8%) and pulmonary disorder (2cases, 2.6%). Older children in female were more likely to have a psychosomatic cause (P= 0.046). The patients complained chest pain on substernal area were 17cases and 13cases (76.5%) were diagnosed as gastrointestinal disorder (P= 0.023). Positive findings of echocardio graphy, 24hr Holter ECG and 24hr pH monitoring were present in 3 (9.4%), 5 (35.7%) and 16 (57.1%) of the patients respectively. Conclusion: Gastrointestinal disorders are common causes and positive diagnostic rate of gastrointestinal evaluation is relatively high in children with chest pain. Old girls are more likely to have a psychosomatic disorder and substernal pain is the reliable sign to be considered as a gastrointestinal disease in children with chest pain. Hence, Diagnostic approach of gastrointestinal disease such as upper GI should be performed basically in mostly children with chest pain.

Psychiatric Characteristics of the Cardiac Outpatients with Chest Pain

최준혁,이재근,김송이,김기석,주승재 대한심장학회 2016 Korean Circulation Journal Vol.46 No.2

Background and Objectives A cardiologist's evaluation of psychiatric symptoms in patients with chest pain is rare. This study aimed to determine the psychiatric characteristics of patients with and without coronary artery disease (CAD) and explore their relationship with the intensity of chest pain. Subjects and Methods Out of 139 consecutive patients referred to the cardiology outpatient department, 31 with atypical chest pain (heartburn, acid regurgitation, dyspnea, and palpitation) were excluded and 108 were enrolled for the present study. The enrolled patients underwent complete numerical rating scale of chest pain and the symptom checklist for minor psychiatric disorders at the time of first outpatient visit. The non-CAD group consisted of patients with a normal stress test, coronary computed tomography angiogram, or coronary angiogram, and the CAD group included those with an abnormal coronary angiogram. Results Nineteen patients (17.6%) were diagnosed with CAD. No differences in the psychiatric characteristics were observed between the groups. "Feeling tense", "self-reproach", and "trouble falling asleep" were more frequently observed in the non-CAD (p=0.007; p=0.046; p=0.044) group. In a multiple linear regression analysis with a stepwise selection, somatization without chest pain in the non-CAD group and hypochondriasis in the CAD group were linearly associated with the intensity of chest pain (β=0.108, R2=0.092, p=0.004; β= -0.525, R2=0.290, p=0.010). Conclusion No differences in psychiatric characteristics were observed between the groups. The intensity of chest pain was linearly associated with somatization without chest pain in the non-CAD group and inversely linearly associated with hypochondriasis in the CAD group. Background and Objectives A cardiologist's evaluation of psychiatric symptoms in patients with chest pain is rare. This study aimed to determine the psychiatric characteristics of patients with and without coronary artery disease (CAD) and explore their relationship with the intensity of chest pain. Subjects and Methods Out of 139 consecutive patients referred to the cardiology outpatient department, 31 with atypical chest pain (heartburn, acid regurgitation, dyspnea, and palpitation) were excluded and 108 were enrolled for the present study. The enrolled patients underwent complete numerical rating scale of chest pain and the symptom checklist for minor psychiatric disorders at the time of first outpatient visit. The non-CAD group consisted of patients with a normal stress test, coronary computed tomography angiogram, or coronary angiogram, and the CAD group included those with an abnormal coronary angiogram. Results Nineteen patients (17.6%) were diagnosed with CAD. No differences in the psychiatric characteristics were observed between the groups. "Feeling tense", "self-reproach", and "trouble falling asleep" were more frequently observed in the non-CAD (p=0.007; p=0.046; p=0.044) group. In a multiple linear regression analysis with a stepwise selection, somatization without chest pain in the non-CAD group and hypochondriasis in the CAD group were linearly associated with the intensity of chest pain (β=0.108, R2=0.092, p=0.004; β= -0.525, R2=0.290, p=0.010). Conclusion No differences in psychiatric characteristics were observed between the groups. The intensity of chest pain was linearly associated with somatization without chest pain in the non-CAD group and inversely linearly associated with hypochondriasis in the CAD group.

Performance of Reperfusion Therapy and Hospital Mortality in ST-Elevation Myocardial Infarction Patients with Non-Chest Pain Complaints

나재필,김민정,신규철,김승환,박유석,정성필,박인철,박준민 연세대학교의과대학 2014 Yonsei medical journal Vol.55 No.3

Purpose: ST-elevation myocardial infarction (STEMI) patients may visit the emergency department (ED) complaining of sensations of pain other than the chest. We investigated our performance of reperfusion therapy for STEMI patients presenting with non-chest pains. Materials and Methods: This was a retrospectiveobservational cohort study. STEMI patients who underwent primary percutaneouscoronary intervention (PCI) were divided into a chest pain group and a non-chest pain group. Clinical differences between the two groups and the influence of presenting with non-chest pains on door-to-electrocardiograms (ECG) time, door-to-balloon time, and hospital mortality were evaluated. Results: Of the 513 patientsdiagnosed with STEMI, 93 patients presented with non-chest pains. Patients in the non-chest pain group were older, more often female, and had a longer symptomonset to ED arrival time and higher Killip class than patients in the chest pain group. There was a statistically significant delay in door-to-ECG time (median, 2.0 min vs. 5.0 min; p<0.001) and door-to-balloon time (median, 57.5 min vs. 65.0 min; p<0.001) in patients without chest pain. In multivariate analysis, presenting with non-chest pains was an independent predictor for hospital mortality (odds ratio,2.3; 95% confidence interval, 1.1-4.7). However, door-to-ECG time and door-to-balloon time were not factors related to hospital mortality. Conclusion: STEMI patients presenting without chest pain showed higher baseline risk and hospital mortality than patients presenting with chest pain. ECG acquisition and primary PCI was delayed for patients presenting with non-chest pains, but not influencing hospital mortality. Efforts to reduce pre-hospital time delay for these patients are necessary.

흉통의 원인으로서 식도성 장애에 관한 연구

황흥곤 世宗醫學硏究所 1993 世宗醫學 Vol.10 No.1

Non-cardiac Chest Pain in Japan: Prevalence, Impact, and Consultation Behavior - A Population-based Study

Junji Chen,Tadayuki Oshima,Takashi Kondo,Toshihiko Tomita,Hirokazu Fukui,Shinichiro Shinzaki,Hiroto Miwa 대한소화기 기능성질환∙운동학회 2023 Journal of Neurogastroenterology and Motility (JNM Vol.29 No.4

Background/AimsNon-cardiac chest pain (NCCP) is defined as recurring angina-like retrosternal chest pain of non-cardiac origin. Information about the epidemiology of NCCP in Japan is lacking. We aim to determine the prevalence and characteristics of NCCP in the Japanese general population. MethodsTwo internet-based surveys were conducted among the general population in March 2017. Questions investigated the characteristics of symptoms associated with chest pain and consultation behavior. Quality of life, anxiety, depression, and gastroesophageal reflux disease were analyzed. ResultsFive percent of the survey respondents reported chest pain. Subjects with chest pain showed higher frequencies of anxiety and depression and lower quality of life. Among subjects with chest pain, approximately 30% had sought medical attention for their symptoms. Among all consulters, 70% were diagnosed with NCCP. Females were less likely to seek consultations for chest pain than males. Further, severity and frequency of chest pain, lower physical health component summary score, and more frequent gastroesophageal reflux disease were associated with consultation behavior. Subjects with NCCP and cardiac chest pain experienced similar impacts on quality of life, anxiety, and depression. Among subjects with NCCP, 82% visited a primary-care physician and 15% were diagnosed with reflux esophagitis. ConclusionsThe prevalence of chest pain in this sample of a Japanese general population was 5%. Among all subjects with chest pain, less than one-third consulted physicians, approximately 70% of whom were diagnosed with NCCP. Sex and both the severity and frequency of chest pain were associated with consultation behavior.

흉부 통증을 호소한 소아에서의 임상적 고찰 및 검사

신수아,김용주,이재환,김남수,문수지,Shin, Su A,Kim, Yong Joo,Lee, Jae Whan,Kim, Nam Su,Moon, Soo Ji 대한소아청소년과학회 2003 Clinical and Experimental Pediatrics (CEP) Vol.46 No.12

목 적 : 소아에 있어서 흉부 통증은 재발성 복통과 더불어 소아과 영역에서 흔히 접하게 되는 문제로, 정확한 원인을 규명하기란 쉽지 않으며 다양한 원인에 의해 발현된다. 소아에서의 흉부 통증은 양성적이고 통증의 경과가 양호하며, 원인을 모르는 경우가 많아 이런 환아들에게서 행해지는 검사가 어떠한 의의가 있는지에 대해서도 정보가 그리 많지 않다. 이에 저자들은 소아 흉부 통증 환자의 특징에 대해 알아보고 검사의 유용성에 대해 알아보고자 본 연구를 시행하였다. 방 법 : 한양대학교병원 소아과에 만성적 흉부 통증을 주소로 내원한 환아 33명(남아 15명, 여아 18명)을 대상으로 흉부 통증의 원인 및 시행하였던 검사들에 대한 결과를 후향적으로 분석하였다. 결 과 : 대상 환아의 연령은 10-12세 사이와 4-6세 사이가 각각 11례(33.3%)로 가장 많은 분포를 보였으며 남, 여 성별의 차이는 없었다. 흉부 통증의 원인으로는 특발성이 15례(45.5%), 심혈관계 검사의 이상을 보인 경우 9례(27.3%), 위장관 질환 6례(18.2%), 호흡기 질환 2례(6%), 흉부 좌상 1례(3%) 순이었다. 대상 환아들에서 보인 심혈관계 검사상 이상 소견은 흉부 통증과 직접적 연관이 있다고 하기 어려웠다. 병력 청취 및 진찰을 통해 상부 위장관 질환이 의심되는 6례에서 이에 대한 검사를 시행하였고 모두에서 상부 위장관 질환의 소견이 관찰되었으며 이에 대한 치료 이후 증상의 재발은 관찰되지 않았다. 결 론 : 소아에서의 흉부 통증은 양성적이고 특발성인 경우가 많으나 심혈관 질환이나 위장관 질환 등의 가능성도 생각해야하며 이를 위해 정확한 병력 청취 및 진찰에 근거해 적절한 검사를 시행함으로써 효과적인 진단 및 치료가 가능할 것이다. Purpose : Chest pain in the pediatric population is not rare and mostly benign. Causes of chest pain are diverse, and differential diagnosis is not easy. Chest pain in children is less likely to be cardiac in origin. Furthermore, chest pain in the pediatric population is rarely associated with life-threatening disease. This study was designed to evaluate children with chest pain and the usefulness of several diagnostic examinations. Methods : Between March 2001 and August 2002, 33 patients(15 boys and 18 girls, aged four to 15 years) presented with chronic chest pain. The records of these patients were reviewed. Chest radiography and electrocardiogram were performed in all patients. Cardiologic and gastrointestinal evaluations were carried out when considered necessary. Results : Chest pain was most common in the age group of 10 to 12 years old, and the four to six years old group. The most common diagnostic findings of chest pain were idiopathic(15 cases, 45.5 %), heart disease(9 cases, 27.3%), upper gastrointestinal disease(6 cases, 18.2%), respiratory disease (2 cases, 6%) and trauma(1 case, 3%). In children with abnormal results of cardiologic evaluation, these findings are not major etiologic categories of chest pain. Through history taking and physical examinations, six cases were evaluated concerning gastrointestinal disease and all of them showed gastrointestinal diseases(esophagitis, gastroesophageal reflux disease, nodular gastritis and chronic superficial gastritis). Conclusion : Chest pain is usually benign in children but the possibility of cardiovascular or gastrointestinal disease is considered. Careful history taking, physical examination and proper clinical examinations are usually required to find out the rare life-threatening causes of chest pain.

협심증이 의심되는 환자에서 운동부하검사로 유발되는 흉통의 양상과 생리적 변인에 관한 연구

조미경,최명애 대한기초간호자연과학회 2000 Journal of korean biological nursing science Vol.2 No.2

The purpose of this study was to identify the characteristics and physiological variables of chest pain induced by exercise test in angina suspected patients. The subjects of this study consisted of 28 inpatients and outpatients aged between 40 and 75 who underwent treadmill test at exercise testing laboratory of S-University from January 2000 to June 2000. Subjects were interviewed with questionnaire regarding sociodemography, the past health history and history related to chest pain before the exercise test. Subjects were interviewed with questionnaire concerning quality, intensity, duration of chest pain induced by walking on the treadmill(Marquette, U.S.A. 1992) according to Bruce protocol following exercise test. Systolic and diastolic blood pressure were measured before, during and after the test, heart rate was determined by ECG. The results of this study were as follows ; 1) Quality of chest pain induced by exercise test were feeling stiffness 19(67.9%), heavy 10(36.0%), exploded 9(32.1%), crushing, suffocating, tight 8(28.6%), stuffy, prickly 7(25.0%), burning 6(21.4%), clasp 5(17.9%), cleaved, tensed, piercing 3(10.7%), perfectly fitting, sore 2(7.1%), tearing, tingling, ticklish, heartburn 1(3.6%). 2) Mean score of VAS(intensity of pain) following exercise test was 5.79?.27 and mean duration of chest pain after the test was 7.83±5.31 minutes. 3) Sites of chest-pain induced by exercise test were middle site 11(39.3%), left-chest 10(35.6%), right-chest 6(21.5%). Radiation site of chest-pain was neck(l8.0%), right flank site 1(3.6%), left shoulder & arm 2(7.1%) and back 1(3.6%). 4) Symptoms other than chest-pain induced by exercise test were dyspnea 21(75.6%), perspiration 14(50.4%), fatigue 12(43.2%), leg-pain 11(39.6%), dizziness 7(25.2%) anxiety toward chest-pain 3(10.8%), thirst 2(7.1%), and palpation, headache and tingling sensation of hand and leg 1(3.6%). 5) Mean MET(intensity of exercise) during the exercise test was 7.64±2.57 and mean RPE(rating of perceived exertion) was 15.89±2.36. Mean duration of exercise was 6.79±2.88. 6) Correlation coefficients between RPE and VAS was 0.500(p=0.003), those between MET and VAS was 0.287(p=0.069) and those between either depression or elevation of ST segment and VAS was 0.236(p=0.114). 7) There was a significant difference in mean systolic pressure between before and after the test as 146.29±28.18mmHg and 177.96±28.82mmHg(t=-5.640, p=0.000), a significant difference in mean diastolic blood pressure between before and after the test as 84.85±15.07mmHg and 88.89±13.72mmHg(t=-2.082,p=0.047), and there was a significant difference in mean heart-rate between before and after the test as 81.89±12.22/min and 160.68±21.77/min(t=-21.255,p=0.000).

Non-Coronary Patients with Severe Chest Pain Show More Irrational Beliefs Compared to Patients with Mild Pain

Mostafa Bahremand,Mozhgan Saeidi,Saeid Komasi 대한가정의학회 2015 Korean Journal of Family Medicine Vol.36 No.4

Background: Despite providing insufficient medical evidence of the existence of a real cardiac condition, patients with non-coronary chest pain still interpret their pain incorrectly. The present study, therefore, sought to compare the irrational beliefs in non-coronary patients with mild chest pain against those with severe chest pain. Methods: A cross-sectional design was used. The statistical population comprised non-coronary patients who presented to the Heart Emergency Center of Kermanshah city, Iran. Using a matching method, 96 participants were selected and studied in two groups of 48. The instruments used were the Comorbidity Index, Brief Pain Index, and the Jones Irrational Beliefs Test (short-form). The multivariate analysis of variance, chi-square test, and t-test were used for data analysis. Results: Controlling for the effects of age and comorbid conditions, the severity of three types of irrational beliefs, including emotional irresponsibility (P<0.001), hopelessness changes (P<0.001), and problem avoiding (P=0.002) was higher among patients with severe chest pain (according to effect level). However, in terms of demand for approval, no difference was seen between the two groups (P=0.180). Conclusion: Non-coronary patients with severe chest pain showed a greater number of irrational beliefs in comparison to patients with mild pain. Irrational beliefs are common mental occurrences in patients with non-coronary chest pain, and they should be attended to by health professionals, especially in severe non-coronary chest pain. Further investigation to determine the association between irrational beliefs and non-coronary chest pain is necessary.

협심증과 구별하기 어려운 흉통을 호소하는 환자중 관상동맥 조영술상 정상인, 비심인성 흉통 환자에서의 식도 운동성 질환에 대한 연구

김용태 ( Kim Yong Tae ),한철주 ( Han Cheol Ju ),김영호 ( Kim Yeong Ho ),정현채 ( Jeong Hyeon Chae ),이명묵 ( Lee Myeong Mug ),박영배 ( Park Yeong Bae ),윤용법 ( Yun Yong Beob ),송인성 ( Song In Seong ),최규완 ( Choe Gyu Wan ),김 대한내과학회 1992 대한내과학회지 Vol.42 No.4

이상의 결과로 협심증과 구별하기 어려운 흉통을 호소하는 환자들에게서 관상동맥 조영술이 정상인 경우, 이들에서 흉통이 원인이 식도질환에서 유래되는지를 알아보기 위하여 이들에게 식도운동검사, Bernstein 검사, edrophonium 유발검사, 24시간 식도 pH측정 들을 실시한 결과 이들의 흉통의 원인으로서 위 식도 역류나 식도의 운동성 질환 등이 중요한 비중을 차지함을 알 수 있다. 그리고 식도 내압 검사 결과 하부식도 괄약근압이 현저히 저하되어 있거나 Bernstein 검사 결과 양성인 경우에는 역류의 확인만을 위해서라면 반드시 24시간 pH검사를 실시할 필요는 없으리라 여겨진다. To assess the frequency of esophageal disease in patients with angina-like chest pain and normal coronary arteriograms, twenty-eight patients underwent esophageal manometric studies, acid perfusion (Bernstein) tests, edrophonium provocation tests, and 24 hr esophageal pH monitorings, and were compaired with the records of 32 normal controls. In the chest pain group, seventeen patients (61%) had abnormal esophageal motility and eleven (39%) had normal motility in the esophageal manometry tests. Two of the 17 (12%) patients with abnormal motility had nutcracker esopohaus, four (24%) had hypotensive lower esophageal sphincter (LES), six (35%) had hypertensive LES, and five (29%) had nonspecific esophageal motility disorder (NEMD). Bernstein test provoked chest pain in 5 patients (18%). Edrophonium injection elicited chest pain in 4 patients, but in only 2 (7%) of the 4 patients the pain was accompanied with abnormal esophageal motility changes. Twenty patients of the chest pain group underwent 24 hour esophageal pH monitorings. Four of the 20 patients (20%) had pathological esophageal refluxes. Twelve patients experienced a total of 70 spontaneous chest pain episodes but only 23 chest pain episodes (43%) in 8 patients were associated with acid refluxes (pH<4.0). Overall, of the 28 patients with non-cardiac chest pain, ten patients (36%) (8 GERD and 2 nutcracker esophagus) had esophageal disease which could be associated definitely with that pain. If manometric study revealed significantly lowered LES pressure or acid perfusion test provocated the identical pain in a patient with chest pain, no further study seemed to be necessary only for the diagnosis of gastroesophageal reflux disease, because the specificity of these tests` results was high.