Mechanical Obstruction

I IMPORTANCE1: After coronary artery disease, the esophageal motility disorders are the 2nd most common stress-related cause of chest pain. 30 % of the 600,000 cardiac catheterizations performed annually show normal coronary arteries. 65 % of those have esophageal motility abnormalities. There are 90,000 such patients in the US who spend an estimated $315 million annually to treat chest pain. II SYMPTOMATOLOGY2: The symptoms caused by the esophageal motility disorders are easily confused with those off coronary artery disease, so the first order of business is to exclude CAD by cardiovascular testing (See the Outline on Stress Testing), especially in patients presenting with chest pain. The combination of 3 complaints: chest discomfort, regurgitation and dysphagia occurs at least occasionally in 68 % of patients with esophageal dysfunction but in only 10 % of cardiac patients. The constellation of symptoms presented by any individual patient depends on the cause. Table 1 lists the various esophageal motility disorders along with the symptoms commonly caused by each. When the presenting symptom is caused by an anatomic obstruction, such as an esophageal web, achalasia or cancer of the esophagus, the patient’s subjective perception of the location of the obstruction is quite accurate (predictive value 89%). III DEFINITIONS: It is important that the patient’s specific symptoms, signs & diagnoses be described wit