Letter from Reykjavik

BACKGROUND AND OBJECTIVES: In previous manometric investigations, we observed that patients with chest pain and arterial hypertension frequently tend to display oesophageal motility abnormalities. Therefore, we set out to study this systematically. METHODS: Patients with chest pain and normal coronary angiogram (n=40) and healthy controls (n=20) were studied prospectively in a standardized fashion using a portable oesophageal manometry and blood pressure registration system over 24 hours. RESULTS: Twenty patients exhibited increased arterial blood pressure (24 h median > 135/85 mmHg), while in the other 20 patients and all controls the 24 h blood pressure patterns were normal. Median pressure amplitudes in the distal oesophagus were 46.5, 33 and 27 mmHg in patients with or without arterial hypertension and controls, respectively, and 30, 27 and 27 mmHg in the proximal oesophagus, respectively. The durations of distal contractions were 3.9, 3.4 and 3.4 s, respectively, and those of proximal contractions were 3.2, 3.0 and 3.2 s, respectively. Percentages of propulsive contractions were 53%, 44% and 59%, respectively, and those of simultaneous contractions were 23%, 25% and 10%, respectively. CONCLUSIONS: Patients and controls differ significantly regarding their oesophageal motility patterns. Patients without arterial hypertension exhibit impaired propulsion of oesophageal contractions, whereas patients with arterial hypertension tend to produce oesophageal hypermotility. This suggests that, depending on the presence or absence of arterial hypertension, different pathomechanisms of oesophageal motility disturbances come into play.