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Edrophonium is the most interesting pharmacological agent for the diagnosis but cannot be regarded as physiologic
A. Gosselin, A. Ropert, M. Gosselin (Rennes)
After the exclusion of cardiac disease, the definitive diagnosis of esophageal chest pain includes the demonstration of simultaneous manometric esophageal changes and chest pain. However, the spontaneous onset of chest pain with abnormal esophageal motility is a rare occurrence during basal manometry and further provocative testing is often required.
Edrophonium test is the most frequently used as a pharmacological agent for esophageal chest pain. Edrophonium chloride is a relatively safe, rapidly acting cholinesterase inhibitor. Unlike ergonovine, edrophonium does not cause significant change in coronary artery diameter, heart rate or systolic blood pressure [7]. Aside from occasional light-headedness, nausea or abdominal cramps, no important side effects requiring treatment with atropine are usually noted [7].
Edrophonium injection produces in normals and in noncardiac chest pain patients an increase in the amplitude and duration of esophageal contractions. This increase characterizes the normal cholinergic effect of the cholinesterase inhibition on the esophagus. In addition, edrophonium provokes chest pain in 18 to 34 p. cent of noncardiac chest pain patients but not in asymptomatic volunteers [1, 3, 4, 5, 7]. The pain is observed within 5 minutes of intravenous injection. The highest incidence is reported by Lee et al. [5] who used a larger dose of edrophonium (10 mg) than other investigators (80 µg/kg).
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