Provocation testing in noncardiac chest pain
dc.contributor.author | Nostrant, Timothy T. | en_US |
dc.date.accessioned | 2006-04-10T15:12:55Z | |
dc.date.available | 2006-04-10T15:12:55Z | |
dc.date.issued | 1992-05-27 | en_US |
dc.identifier.citation | Nostrant, Timothy T. (1992/05/27)."Provocation testing in noncardiac chest pain." The American Journal of Medicine 92(5, Supplement 1): S56-S64. <http://hdl.handle.net/2027.42/30039> | en_US |
dc.identifier.uri | http://www.sciencedirect.com/science/article/B6TDC-4F1SPF3-X/2/358b5383897630ce45acd7a80659279d | en_US |
dc.identifier.uri | https://hdl.handle.net/2027.42/30039 | |
dc.description.abstract | The ability to reproduce chest pain and to identify the esophagus as the source of this pain are the major reasons why provocation testing has become standard in the evaluation of patients with noncardiac chest pain. Recent studies that challenge the validity of performing provocation tests have polarized experts into two camps: those who would abandon such testing because of its low sensitivity and low specificity, and those who would use testing judiciously because of moderate increases in diagnostic yield. Use of 24-hour pH and pressure testing has shown a high number of chest pain events associated with acid reflux in patients with positive cholinergic stimulation tests and esophageal dysmotility, as well as pain with esophageal dysmotility in patients with positive acid infusion tests. Mechanisms of esophageal chest pain are not known. All provocation agents can decrease coronary flow reserve (i.e., induce microvascular angina), thus raising the question of a cardiac source of pain even in patients with positive presumed esophageal provocation. Acid infusion, cholinergic stimulation, and balloon distention are discussed in light of 24-hour pH and pressure monitoring. Esophageal distention and the role of acid in inducing chest pain are emphasized. The role of stress, the use of defined stressors to induce chest pain, and altered pain perception as a final common pathway for chest pain are examined. | en_US |
dc.format.extent | 1155252 bytes | |
dc.format.extent | 3118 bytes | |
dc.format.mimetype | application/pdf | |
dc.format.mimetype | text/plain | |
dc.language.iso | en_US | |
dc.publisher | Elsevier | en_US |
dc.title | Provocation testing in noncardiac chest pain | en_US |
dc.type | Article | en_US |
dc.rights.robots | IndexNoFollow | en_US |
dc.subject.hlbsecondlevel | Family Medicine and Primary Care | en_US |
dc.subject.hlbtoplevel | Health Sciences | en_US |
dc.description.peerreviewed | Peer Reviewed | en_US |
dc.contributor.affiliationum | Division of Gastroenterology, Department of Internal Medicine, University of Michigan Hospitals and School of Medicine, Ann Arbor, Michigan, USA | en_US |
dc.description.bitstreamurl | http://deepblue.lib.umich.edu/bitstream/2027.42/30039/1/0000407.pdf | en_US |
dc.identifier.doi | http://dx.doi.org/10.1016/0002-9343(92)80058-8 | en_US |
dc.identifier.source | The American Journal of Medicine | en_US |
dc.owningcollname | Interdisciplinary and Peer-Reviewed |
Files in this item
Remediation of Harmful Language
The University of Michigan Library aims to describe library materials in a way that respects the people and communities who create, use, and are represented in our collections. Report harmful or offensive language in catalog records, finding aids, or elsewhere in our collections anonymously through our metadata feedback form. More information at Remediation of Harmful Language.
Accessibility
If you are unable to use this file in its current format, please select the Contact Us link and we can modify it to make it more accessible to you.