| AIMS: The research was designed to explore the significance of esophageal motility testing, 24-hour esophageal pH monitoring and Holter monitoring electrocardiogram in the diagnosis of unclear chest pain and to provid a theoretical basis for clinical treatment .Methods: From September.2001 to April.2003, forty-six outpatients and inpatients with repeatedly unclear chest pain admitted in our department were examined with esophageal motility testing, 24-hour esophageal pH monitoring and Holter monitoring electrocardiogram The patients with simple esophageal motility disorders were given orally dianqie mixture and motilium; The patients with gastro-esophageal reflux were treated with orally losec and motilium for 2 weeks and then re-examined; The patients with myocardial ischemia were given Aspirin, β-receptor blocker, ACEI and Nitroglycerin. The patients with achalasia of cardia were treated with Heller operation plus foldings of stomach fundus. Then linear correlation analysis was done with LESP and DeMeester scores as variances and correlation coefficient was checked. The average values of LESP, LESRR, systolic pressure, conduction rate and DeMeester score in the reviewed patients were compared by T test.RESULTS:1,In the 46 patients, there were 34 cases who had esophageal motility disorders and 6 cases with myocardial ischemia. In the 34 cases, there were 24 cases with nonspecific esophageal motility disorders (14 cases with gastro-esophageal reflux and 4 cases with myocardial ischemia) , 5 cases with achalasia of cardia (1 case with gastro-esophageal reflux) ,4 cases with diffuse spasm of esophagus(4 cases with gastro-esophageal reflux and 2 cases with myocardial ischemia), and 1 case with nutcracker esophagus.2,In the cases with nonspecific esophageal motility disorders, the relaxations of lower esophageal sphincters decreased and there were spontaneously non- conductibility contraction waves and there might be high amplitude contraction waves which indicated limited spasms. LESP of achalasia of cardia was normal or slightly higher and the relaxations of lower esophageal sphincters decreased. The normal primary peristalsising ofesophagus in achalasia of cardia was lost which indicated low amplitude contractions. At the same time the cases with achalasia of cardia could have concurrent gastro-esophageal reflux. The LESRR of diffuse spasm of esophagus decreased and there were repeated, simultaneous, high amplitude and long time contractions. The lower Esophageal pressure was very high at the diffuse spasm of esophagus. The cases with nutcracker esophagus had high amplitude contractions. The cases with gastro-esophageal reflux sustained all kinds of esophageal motility disorders including nonspecific esophageal motility disorders and diffuse spasm of esophagus and achalasia of cardia . LESP and LESRR decreased in most patients. The cases with myocardial ischemia occurred in esophageal motility disorders or gastro-esophageal reflux. In 4 cases with gastro-esophageal reflux, 2 had simultaneous gastro-esophageal reflux with myocardial ischemia.3,The DeMeester scores in the 14 cases with low LESP were of negative correlation with LESP, the correlation coefficient was -0.428,P<0.005, that meant the decrease of LESP was the most important reason of GERD. But the DeMeester scores in the 31 cases whose LESP was normal had no correlation with LESP, showing less possibility of GERD when LESP is normal.4,The symptoms of achalasia of cardia were relieved after Heller operation plus foldings of stomach fundus. The 10 patients with simple esophageal motility disorders were given orally dianqie mixture 10ml 1/d and motilium 10mg 3/d; The 19 patients with gastro-esophageal reflux were given orally losec 20mg 1/d and motilium 10mg 3/d and then re-examined. The symptoms of 15 cases(51.7%) with chest pain had extincted ,there was improvement in 6 cases(20.7%), inefficiency in 5 cases(17.2%), and 3 cases failed to be followed up. Re-examination of the 8 cases with gastro-esophageal reflux indicated that th...
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