Ten patients with anginal symptoms and ergonovine-induced chest pain without coronary artery spasm had esophageal manometry with provocative pharmacologic testing. Increased amplitude of esophageal contractions on baseline manometry (68.2 ± 10.3 mmHg) was the only characteristic discriminating these patients from normals (40.9 ± 6.3 mmHg) and from patients with esophageal motility disorders (39.6 ± 7.5 mmHg). The administration of ergonovine or edrophonium provoked typical chest pain in association with high amplitude, long duration, and repetitive esophageal contractions in all 10 patients. Patients with esophageal motor disorders showed a similar, but less marked esophageal response with pain infrequently produced. Normals showed no response to ergonovine, and a minimal response to edrophonium, but without chest pain. Clinical features of patients with ergonovine-induced chest pain could not distinguish them from patients with coronary artery disease; esophageal symptoms were infrequent and mild. These studies suggest that certain patients with chest pain of esophageal origin may be identified only by provocative testing during esophageal manometry. However, these provocative drugs may also induce coronary artery spasm and should not be used during routine clinical manometry.
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