Digestive Diseases and Sciences
Volume 35, Number 12, 1445-1451, DOI: 10.1007/BF01540560

Published in partnership with the

Logo

Gastroenterology Research Group

Original Articles

Edrophonium provocative test in noncardiac chest pain
Evaluation of testing techniques

Christine B. Dalton, Edward G. Hewson, Donald O. Castell and Joel E. Richter

View Related Documents

Abstract

Edrophonium chloride is used frequently as a provocative agent in the assessment of noncardiac chest pain (NCCP). However, the optimum dose and most appropriate method of interpreting test results is controversial. We studied 150 consecutive NCCP patients and 50 age-matched controls who alternately received either 80 mgrg/kg or 10 mg intravenous bolus doses of edrophonium preceded by saline placebo injections. Distal esophageal pressures were measured before and after drug injection in response to ten 5-cc wet swallows. Following 10 mg of edrophonium, 33% of patients and 4% of controls reported chest pain, while 29% of patients and no controls receiving the 80 mgrg/kg dose complained of chest pain. Amplitude changes after either dose were not significantly different for all comparisons, but the duration of response did distinguish the two doses in patients with chest pain. A significantly greater (P=0.01) increase in distal contraction duration occurred after 10 mg (74±12%; ±se) compared to 80 mgrg/kg dose (43± 6%). However, individual responses to the two doses overlapped considerably. If a positive test is redefined to include both chest pain and manometric changes that are significantly different from controls, the positivity rate changes drastically; 33% to 9% in the 10- mg group and 30% to 3% in the 80- mgrg/kg group. Side effects were similar between doses, but there was a significant (P=0.02) linear relationship between intensity of side effects and the edrophonium dose per kilogram of body weight. From this study and a review of the literature, we conclude that either dose of edrophonium is appropriate for provocative testing but that the interpretation of results is dependent upon technique.

Key words  chest pain - esophageal motility disorders - edrophonium - diffuse spasm

Fulltext Preview

Image of the first page of the fulltext document