Use of the intraesophageal acid perfusion test in provoking nonspecific chest pain in children.

The intraesophageal acid perfusion (Bernstein) test was evaluated as a provocative test for nonspecific chest pain in children with esophagitis. Sixty patients with atypical chest pain were studied. None of the patients had heartburn or other characteristic symptoms of esophagitis. Forty-five patients had esophagitis; in 18 (40%) of these patients, pain replicating their usual symptoms developed during esophageal acid perfusion, whereas in 15 patients without esophagitis, chest pain did not develop during esophageal acid perfusion. In three patients with esophagitis, esophageal manometric abnormalities and chest pain developed as a result of esophageal acid perfusion. Treatment with either ranitidine or antacids had equivalent effectiveness. We conclude that a positive Bernstein test result in children with nonspecific chest pain indicates that the pain is likely associated with esophageal disease.