Non-cardiac chest pain (NCCP) is a common disorder whose pathophysiology is poorly understood. Some evidence suggests it may be related to sustained esophageal contractions (SECs) of longitudinal smooth muscle. The investigators have previously shown that acid is a trigger for SECs and results in shortening of the esophagus. In this study, the investigators plan to prospectively evaluate esophageal shortening responses to acid in a group of patients with NCCP compared to controls. The investigators will use high resolution esophageal manometry coupled with acid infusion to evaluate shortening. The investigators hypothesize that at least a subset of patients with NCCP will have an exaggerated esophageal shortening response to acid which correlates with symptom production. If our hypothesis proves true, this may lead to a future therapeutic target in the treatment of these patients.
Study Type
OBSERVATIONAL
Enrollment
40
Both cohorts will undergo standard high resolution esophageal manometry testing. This entails a catheter passed through the nose into the esophagus and measures pressure changes with a series of wet swallows. As part of the study, we will also be instilling both weak acid and saline into the esophagus.
Hotel Dieu Hospital
Kingston, Ontario, Canada
Mean Change in Esophageal Length With Acid
Mean length of esophagus with acid infusion minus mean length of esophagus with saline infusion
Time frame: Length at T= 20 minutes - Baseline (T=0)
Esophageal Length at Symptom Onset
Length of Esophagus as measured by manometry during acid infusion when patient reports symptoms
Time frame: 20 minutes
Esophageal Length at Maximal Symptom Intensity
Mean length of esophagus at peak patient reported symptom intensity with acid infusion
Time frame: 20 minutes
Number of Participants for Whom a Correlation Was Found Between Symptom Onset and Esophageal Shortening
Esophageal shortening will be defined as the point during the 20 minute acid infusion at which the lower esophageal sphincter begins to migrate proximally. A 2 minute window following this time point will then be used to determine if patients symptoms increased by \> 2 on a visual analogue pain scale between 0 - 10.
Time frame: 20 minutes
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