Hyperventilation and esophageal dysmotility in patients with noncardiac chest pain.

OBJECTIVES

Hyperventilation is known to cause esophageal spasm, but the importance of this interaction in clinical practice is unknown. In the present study, we report the effects of hyperventilation provocation on esophageal motility in a consecutive series of patients with noncardiac chest pain.

METHODS

In a prospective observational study design, 46 consecutive patients with normal coronary angiograms were studied. Esophageal motility was recorded at rest and after voluntary over-breathing at 40 breaths/min for 3 min.

RESULTS

Hyperventilation was associated with a significant fall in mean distal peristaltic amplitude [66 (SD 28) to 55 (SD 24) mm Hg, p <0.001] and mean duration [2.9 (SD 0.7) to 2.6 (SD 0.9) s,p = 0.02]. It induced diffuse spasm in two (4%) patients, and nonspecific motility disorders in 10 (22%). Chest pain was reproduced in seven (15%) patients, but in none did this coincide with an important change in peristaltic amplitude, duration, or frequency.

CONCLUSION

Hyperventilation has important effects on esophageal motility, and manometrists should be aware of these before recommending that anxious patients overbreathe to help relaxation during clinical studies. Although overbreathing is a common source of dysmotility, it rarely produces chest pain via its effects on the esophagus.