Edrophonium: a useful provocative test for esophageal chest pain

Ann Intern Med. 1985 Jul;103(1):14-21. doi: 10.7326/0003-4819-103-1-14.

Abstract

Esophageal motility disorders may be an important cause of noncardiac chest pain. To improve our diagnostic yield, we studied the use of edrophonium as a provocative test for inducing esophageal chest pain in 50 symptomatic patients without coronary artery disease and in 25 age-matched controls. Edrophonium (80 micrograms/kg of body weight, intravenous bolus) induced chest pain in 15 (30%) patients and in no controls. Edrophonium increased esophageal amplitude and repetitive contractions to a similar degree in all subjects, but the change in duration (101 +/- 13% [SE] was significantly greater (p less than 0.02) in patients in whom chest pain was induced. Drug specificity was assessed in 9 patients during cardiac catheterization, but no significant change was seen in coronary artery diameter, blood pressure, or heart rate. Further clinical testing using a placebo control confirmed a positivity rate of 28% in 125 unselected patients with chest pain referred to our laboratory; false-positive tests were infrequent (5.6%). No important side effects were seen. Edrophonium is useful for provoking esophageal chest pain.

MeSH terms

  • Adult
  • Aged
  • Coronary Angiography
  • Coronary Vessels / drug effects
  • Edrophonium*
  • Esophageal Diseases / complications
  • Esophageal Diseases / diagnosis*
  • Esophagus / drug effects
  • Esophagus / physiopathology
  • Female
  • Hemodynamics / drug effects
  • Humans
  • Male
  • Manometry
  • Middle Aged
  • Pain / etiology*
  • Peristalsis / drug effects
  • Thorax*

Substances

  • Edrophonium