FOLLOW-UP OF PATIENTS WITH CHEST PAIN AND NORMAL CORONARY ANGIOGRAPHY - THE IMPACT OF ESOPHAGEAL INVESTIGATIONS

In order to determine whether diagnosis of a potential oesophageal source of chest pain influences outcome in patients with recurrent angina-like chest pain and normal coronary angiography, 96 individuals were retrospectively identified. These included 52 who had oesophageal investigations (showing an abnormality in 31) and 44 who did not. All patients and their general practitioners (GP) were sent a postal enquiry regarding functional status. Diagnosis of an oesophageal abnormality improved neither resolution of chest pain nor return to normal activities nor likelihood of return to employment over a median follow-up period of 3 years. Patients who had oesophageal tests were more likely (P < 0.005) to be unsure of the cause of their chest pain, despite their GPs being more likely (P < 0.001) to accept the oesophagus as the origin of symptoms. The results suggest that the message of a non-cardiac source of symptoms is not well understood or accepted by these patients and that more attention should be directed towards clear and repeated communication with them. This aspect of management of patients with angina-like chest pain requires at least as much attention as which tests (cardiac or oesophageal) are appropriate.