Diagnostic utility of the oesophageal balloon distension test in the evaluation of oesophageal chest pain.

BACKGROUND: Oesophageal balloon distension test (EBDT) has been advocated for the evaluation of functional oesophageal noncardiac chest pain (NCCP), but its diagnostic utility remains unclear. AIM: To prospectively assess the diagnostic yield of EBDT in clinical practice and compare its yield with standard oesophageal tests. METHODS: Over a period of 6 years, patients with chest pain and negative cardiac work-up underwent sequential testing with endoscopy/biopsy, oesophageal manometry, 24 h pH study and EBDT to elucidate an oesophageal source for their symptoms. Patients with a definite abnormality, for example, erosive oesophagitis on oesophagogastroduodenoscopy (EGD) were designated as having positive test and excluded from further work up. RESULTS: Of 348 (m/f = 105/243) suspected NCCP patients, 16 (5%) were excluded; 332 (95%) underwent oesophageal testing. Among these, 48 (14%) had macro/microscopic oesophagitis on endoscopy, 7 (2%) had achalasia and 96 (28%) had excessive acid reflux (pH study). The remaining 181 (52%) patients underwent EBDT; 128 (37%) had oesophageal hypersensitivity. Chest pain was reproduced in 97/128 (75%) subjects. There were no adverse effects. CONCLUSIONS: Oesophageal testing can reveal an oesophageal source for chest pain in 86% of NCCP subjects. The majority (42%) of patients had gastro-oesophageal reflux disease (GERD). Oesophageal balloon distension test identified hypersensitivity in over one-third of subjects. The oesophageal balloon distension test provides useful diagnostic information and should be performed routinely in patients with NCCP after excluding GERD.