{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,7]],"date-time":"2025-12-07T03:45:30Z","timestamp":1765079130722,"version":"3.46.0"},"reference-count":36,"publisher":"BMJ","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Gut"],"published-print":{"date-parts":[[1992,5]]},"abstract":"<jats:p>Ten healthy volunteers and 13 patients with oesophageal motility disorders whose primary presenting complaint was chest pain were studied by distending an intraoesophageal balloon in 1 ml steps to the point of a sensation of discomfort. The net balloon pressure (intra-balloon pressure when inflated within the oesophagus minus the pressure recorded at the same volume outside the patient) was measured at each volume increment and the distension volume at the perception of discomfort was noted. The measurements were repeated after intravenous injection of edrophonium (80 micrograms\/kg) and again after 1.2 mg intravenous atropine. Oesophageal wall compliance was similar in patients and controls, and the two groups showed a similar effect of decreased compliance with edrophonium and increased compliance after atropine. There were no significant differences between patients and controls of distending volume at perception of discomfort. Edrophonium, however, resulted in a significant reduction in distension threshold for pain (p less than 0.03) in patients. A similar though non-significant trend was seen in controls. In both controls and patients, distension volume for pain production after atropine was significantly (p less than 0.01) higher than after edrophonium. From these results and other published data, we suggest that the pain receptor for noxious stretch and after edrophonium challenge is likely to be an 'in series' mechanoreceptor located in oesophageal longitudinal muscle.<\/jats:p>","DOI":"10.1136\/gut.33.5.580","type":"journal-article","created":{"date-parts":[[2007,9,18]],"date-time":"2007-09-18T17:41:31Z","timestamp":1190137291000},"page":"580-586","source":"Crossref","is-referenced-by-count":32,"title":["Site and mechanism of pain perception with oesophageal balloon distension and intravenous edrophonium in patients with oesophageal chest pain."],"prefix":"10.1136","volume":"33","author":[{"given":"J S","family":"de Caestecker","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A","family":"Pryde","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R C","family":"Heading","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[1992,5,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"14","DOI":"10.7326\/0003-4819-103-1-14","article-title":"Edrophonium: a useful provocative test for esophageal chest pain","volume":"103","author":"Richter, J.E.; Hackshaw, B.T.; Wu, W.C.; Castell, D.O.","year":"1985","unstructured":"Richter JE, Hackshaw BT, Wu WC, Castell DO. Edrophonium: a useful provocative test for esophageal chest pain. Ann Intern Med 1985; 103: 14-21.","journal-title":"Ann Intern Med"},{"key":"ref_2","first-page":"18","article-title":"Provocative tests in chest pain presumed to be of esophageal origin","volume":"2","author":"Castell, D.O.","year":"1990","unstructured":"Castell DO. Provocative tests in chest pain presumed to be of esophageal origin. Eur J Gastroenterol Hepatol 1990; 2: 18-20.","journal-title":"Eur J Gastroenterol Hepatol"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"593","DOI":"10.7326\/0003-4819-106-4-593","article-title":"Esophageal testing of patients with noncardiac chest pain or dysphagia: results of three years' experience with 1161 patients","volume":"106","author":"Katz, P.O.; Dalton, C.B.; Richter, J.E.; Wu, W.C.; Castell, D.O.","year":"1987","unstructured":"Katz PO, Dalton CB, Richter JE, Wu WC, Castell DO. Esophageal testing of patients with noncardiac chest pain or dysphagia: results of three years' experience with 1161 patients. Ann Intern Med 1987; 106: 593-7.","journal-title":"Ann Intern Med"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1007\/BF01296132","article-title":"Esophageal chest pain: value of high-dose provocative testing with edrophonium chloride in patients with normal esophageal manometries","volume":"32","author":"Lee, C.A.; Reynolds, J.C.; Ouyang, A.; Baker, L.; Cohen, S.","year":"1987","unstructured":"Lee CA, Reynolds JC, Ouyang A, Baker L, Cohen S. Esophageal chest pain: value of high-dose provocative testing with edrophonium chloride in patients with normal esophageal manometries. Dig Dis Sci 1987; 32: 682-8.","journal-title":"Dig Dis Sci"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/0016-5085(81)90645-4","article-title":"Provocation of esophageal pain by ergonovine or edrophonium","volume":"81","author":"London, R.L.; Ouyang, A.; Snape, W.J.; Goldberg, S.; Hirshfeld, J.W.; Cohen, S.","year":"1981","unstructured":"London RL, Ouyang A, Snape WJ, Goldberg S, Hirshfeld JW, Cohen S. Provocation of esophageal pain by ergonovine or edrophonium. Gastroenterology 1981; 81: 10-4.","journal-title":"Gastroenterology"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/S0016-5085(19)32195-X","article-title":"Symptomatic diffuse esophageal spasm: manometric follow up and response to cholinergic stimulation and cholinesterase inhibition","volume":"73","author":"Mellow, M.","year":"1977","unstructured":"Mellow M. Symptomatic diffuse esophageal spasm: manometric follow up and response to cholinergic stimulation and cholinesterase inhibition. Gastroenterology 1977; 73: 237-40.","journal-title":"Gastroenterology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1136\/gut.29.8.1029","article-title":"Comparison of intravenous edrophonium and oesophageal acid perfusion during oesophageal manometry in patients with non-cardiac chest pain","volume":"29","author":"de Caestecker JS; A, Pryde; RC, Heading","year":"1989","unstructured":"de Caestecker JS, Pryde A, Heading RC. Comparison of intravenous edrophonium and oesophageal acid perfusion during oesophageal manometry in patients with non-cardiac chest pain. Gut 1989; 29: 1029-34.","journal-title":"Gut"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1688","DOI":"10.1016\/0016-5085(90)90475-G","article-title":"Role ofvisceral afferent mechanisms in functional bowel disorders","volume":"99","author":"Mayer, E.A.; Raybould, H.E.","year":"1990","unstructured":"Mayer EA, Raybould HE. Role ofvisceral afferent mechanisms in functional bowel disorders. Gastroenterology 1990; 99: 1688-704.","journal-title":"Gastroenterology"},{"issue":"17","key":"ref_9","first-page":"53","article-title":"Visceral pain in the upper alimentary tract","volume":"1923","author":"Payne, W.W.; Poulton, E.P.","unstructured":"Payne WW, Poulton EP. Visceral pain in the upper alimentary tract. QJrMed 1923; 17: 53-82.","journal-title":"QJrMed"},{"key":"ref_10","first-page":"610","article-title":"Observations on the nature of 'Heart-Burn'","volume":"2","author":"Jones, C.M.; Richardson, W.","year":"1926","unstructured":"Jones CM, Richardson W. Observations on the nature of 'Heart-Burn'. [Abstract]. J Clin Invest 1926; 2: 610.","journal-title":"J Clin Invest"},{"issue":"10","key":"ref_11","first-page":"435","article-title":"Experimental referred pain from the gastrointestinal tract. Part 1: the esophagus","volume":"1931","author":"Polland, W.S.; Bloomfield, A.L.","unstructured":"Polland WS, Bloomfield AL. Experimental referred pain from the gastrointestinal tract. Part 1: the esophagus. J Clin Invest 1931; 10:435-52.","journal-title":"J Clin Invest"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1172\/JCI103581","article-title":"Studies of visceral pain: measurements of stimulus intensity and duration associated with the onset of pain in esophagus, ileum and colon","volume":"37","author":"Lipkin, M.; Sleisenger, M.H.","year":"1958","unstructured":"Lipkin M, Sleisenger MH. Studies of visceral pain: measurements of stimulus intensity and duration associated with the onset of pain in esophagus, ileum and colon. J Clin Invest 1958; 37: 28-34.","journal-title":"J Clin Invest"},{"key":"ref_13","first-page":"632","article-title":"Pain due to esophageal distension","volume":"8","author":"Flood, C.A.; Fink, S.; Mathers, J.","year":"1963","unstructured":"Flood CA, Fink S, Mathers J. Pain due to esophageal distension. AmJ DigDis 1963; 8: 632-8.","journal-title":"AmJ DigDis"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1016\/S0016-5085(19)35947-5","article-title":"Comparison of experimental esophageal pain with clinical pain of angina pectoris and esophageal disease","volume":"29","author":"Kramer, P.; Hollander, W.","year":"1955","unstructured":"Kramer P, Hollander W. Comparison of experimental esophageal pain with clinical pain of angina pectoris and esophageal disease. Gastroenterology 1955; 29: 719-43.","journal-title":"Gastroenterology"},{"key":"ref_15","first-page":"143","article-title":"Observations on distension of the lower end of the oesophagus","volume":"14","author":"Baylis, J.H.; Kauntze, R.; TrounceJR","year":"1955","unstructured":"Baylis JH, Kauntze R, TrounceJR. Observations on distension of the lower end of the oesophagus. Q J Med 1955; 14: 143-54.","journal-title":"Q J Med"},{"key":"ref_16","first-page":"1292","article-title":"Graded esophageal balloon distension: a new provocative test for non-cardiac chest pain","volume":"31","author":"Barish, C.F.; Castell, D.O.; Richter, J.E.","year":"1986","unstructured":"Barish CF, Castell DO, Richter JE. Graded esophageal balloon distension: a new provocative test for non-cardiac chest pain. Dig Dis Sci 1986; 31: 1292-8.","journal-title":"Dig Dis Sci"},{"key":"ref_17","first-page":"938","article-title":"Intraesophageal balloon distension versus drug provocation in the evaluation of non-cardiac chest pain","volume":"85","author":"Deschner, W.K.; Maher, K.A.; Cattau, E.L.; Benjamin, S.B.","year":"1990","unstructured":"Deschner WK, Maher KA, Cattau EL, Benjamin SB. Intraesophageal balloon distension versus drug provocation in the evaluation of non-cardiac chest pain. Am J Gastroenterol 1990; 85: 938-43.","journal-title":"Am J Gastroenterol"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/0016-5085(89)90817-2","article-title":"Diagnostic value of esophageal balloon distension (letter)","volume":"%:","author":"Kramer, P.","year":"1989","unstructured":"Kramer P. Diagnostic value of esophageal balloon distension (letter). Gastroenterology 1989; %: 271-2.","journal-title":"Gastroenterology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1161\/01.CIR.71.2.218","article-title":"Left ventricular dysfunction in patients with angina pectoris, normal epicardial coronary arteries and abnormal vasodilator reserve","volume":"71","author":"Cannon, R.O.; Bonow, R.O.; Bacharach, S.L.; Green, M.V.; Rosing, D.R.; Leon, M.B.","year":"1985","unstructured":"Cannon RO, Bonow RO, Bacharach SL, Green MV, Rosing DR, Leon MB, et al. Left ventricular dysfunction in patients with angina pectoris, normal epicardial coronary arteries and abnormal vasodilator reserve. Circulation 1985; 71: 218-26.","journal-title":"Circulation"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1016\/0016-5085(86)90685-2","article-title":"Abnormal sensory perception in patients with esophageal chest pain","volume":"91","author":"Richter, J.E.; Barish, C.F.; Castell, D.O.","year":"1986","unstructured":"Richter JE, Barish CF, Castell DO. Abnormal sensory perception in patients with esophageal chest pain. Gastroenterology 1986; 91: 845-52.","journal-title":"Gastroenterology"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/0002-9343(52)90082-X","article-title":"A physiologic and clinical consideration of the pressures developed in the digestive tract","volume":"13","author":"QuigleyJP, Brody D.A.","year":"1952","unstructured":"QuigleyJP, Brody DA. A physiologic and clinical consideration of the pressures developed in the digestive tract. AmJ3 Med 1952; 13: 73-81.","journal-title":"AmJ3 Med"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1136\/gut.29.2.161","article-title":"Functional relationships between cricopharangeal sphincter and oesophageal body in response to graded intraluminal distension","volume":"29","author":"Andreollo, N.A.; Thompson, D.G.; Kendall, G.P.N.; Earlam, R.J.","year":"1988","unstructured":"Andreollo NA, Thompson DG, Kendall GPN, Earlam RJ. Functional relationships between cricopharangeal sphincter and oesophageal body in response to graded intraluminal distension. Gut 1988; 29: 161-6.","journal-title":"Gut"},{"issue":"48","key":"ref_23","first-page":"408","article-title":"Esophageal response to distension and electrical stimulation","volume":"1969","author":"Christensen, J.; Lund, G.E.","unstructured":"Christensen J, Lund GE. Esophageal response to distension and electrical stimulation. J Clin Invest 1969; 48: 408-19.","journal-title":"J Clin Invest"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1016\/S0016-5085(72)80142-2","article-title":"Alteration of lower esophageal sphincter characteristics with respiration and proximal esophageal balloon distension","volume":"62","author":"Winans, C.S.","year":"1972","unstructured":"Winans CS. Alteration of lower esophageal sphincter characteristics with respiration and proximal esophageal balloon distension. Gastroenterology 1972, 62: 380-8.","journal-title":"Gastroenterology"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1152\/jappl.1973.35.6.851","article-title":"A comparison between primary esophageal peristalsis following wet and dry swallows","volume":"35","author":"Dodds, W.J.; Hogan, W.J.; Reid, D.P.; Stewart, E.T.; Arndorfer, R.C.","year":"1973","unstructured":"Dodds WJ, Hogan WJ, Reid DP, Stewart ET, Arndorfer RC. A comparison between primary esophageal peristalsis following wet and dry swallows. Jf Appi Physiol 1973; 35: 851-7.","journal-title":"Jf Appi Physiol"},{"key":"ref_26","first-page":"1292","article-title":"Upper esophageal response to intraluminal","volume-title":"distension in man. Gastroenterology 1977; 72","author":"Enzmann, D.R.; Harell, G.S.; Zboralske, F.E.","unstructured":"Enzmann DR, Harell GS, Zboralske FE. Upper esophageal response to intraluminal distension in man. Gastroenterology 1977; 72: 1292-8."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1152\/jappl.1957.10.3.498","article-title":"Motor responses of the esophagus to distension","volume":"10","author":"Creamer, B.; Schegel, J.","year":"1957","unstructured":"Creamer B, Schegel J. Motor responses of the esophagus to distension. J Appl Physiol 1957; 10: 498-504.","journal-title":"J Appl Physiol"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1391","DOI":"10.1172\/JCI105631","article-title":"The esophageal propulsive force: esophageal response to acute obstruction","volume":"46","author":"Winship, D.H.; Zboralske, F.F.","year":"1967","unstructured":"Winship DH, Zboralske FF. The esophageal propulsive force: esophageal response to acute obstruction. J Clin Invest 1967; 46: 1391-401.","journal-title":"J Clin Invest"},{"key":"ref_29","first-page":"1020","article-title":"Pharmacologic testing of esophageal muscle wall responses to balloon distension","volume-title":"primates [Abstract]. Gastroenterology","volume":"86","author":"Barish, C.F.; Richter, J.E.; Blackwell, J.N.; Castell, D.O.","year":"1984","unstructured":"Barish CF, Richter JE, Blackwell JN, Castell DO. Pharmacologic testing of esophageal muscle wall responses to balloon distension in primates [Abstract]. Gastroenterology 1984; 86: 1020."},{"issue":"38","key":"ref_30","first-page":"582","article-title":"A study of the effect of various drugs on esophageal motility","volume":"1960","author":"Flood, C.A.; Fink, S.","unstructured":"Flood CA, Fink S. A study of the effect of various drugs on esophageal motility. Gastroenterology 1960; 38: 582-6.","journal-title":"Gastroenterology"},{"key":"ref_31","first-page":"592","article-title":"Oesophageal ischaemia in motility disorders associated with chest pain","volume":"ii:","author":"Mackenzie, J.; Belch, J.; Land, D.; Park, R.; McKillip, J.","year":"1988","unstructured":"Mackenzie J, Belch J, Land D, Park R, McKillip J. Oesophageal ischaemia in motility disorders associated with chest pain. Lancet 1988; ii: 592-5.","journal-title":"Lancet"},{"key":"ref_32","first-page":"425","article-title":"Esophageal ischemia: does it play a role","volume-title":"non-cardiac chest pain? Gastroenterology 1989; 96","author":"Rosen, A.M.; Maher, K.A.; Cattau, E.L.; Benjamin, S.","unstructured":"Rosen AM, Maher KA, Cattau EL, Benjamin S. Esophageal ischemia: does it play a role in non-cardiac chest pain? Gastroenterology 1989; 96: A425."},{"key":"ref_33","first-page":"132","article-title":"Ischemia a possible mechanism of","volume-title":"esophageal chest pain? Gastroenterology 1989; 96","author":"Duda, G.; Bass, B.; Huesken, J.E.; Wall, S.; Harman, J.W.","unstructured":"Duda G, Bass B, Huesken JE, Wall S, Harman JW. Ischemia a possible mechanism of esophageal chest pain? Gastroenterology 1989; 96: A132."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1152\/jn.1990.64.3.796","article-title":"Stimulus - response function studies of esophageal mechanosensitive nociceptors in sympathetic afferents of opossum","volume":"64","author":"Sengupta, J.N.; Saha, JR, Goyal; R.K.","year":"1990","unstructured":"Sengupta JN, Saha JR, Goyal RK. Stimulus - response function studies of esophageal mechanosensitive nociceptors in sympathetic afferents of opossum. J Neurophysiol 1990; 64: 796-812.","journal-title":"J Neurophysiol"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1152\/jn.1989.61.5.1001","article-title":"Characteristics of vagal esophageal tension - sensitive afferent fibers in the opossum","volume":"61","author":"Sengupta, J.N.; Kauvar, D.; Goyal, R.K.","year":"1989","unstructured":"Sengupta JN, Kauvar D, Goyal RK. Characteristics of vagal esophageal tension - sensitive afferent fibers in the opossum. JNeurophysiol 1989; 61: 1001-10.","journal-title":"JNeurophysiol"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1152\/jn.1969.32.6.1025","article-title":"Response of cutaneous sensory units with unmyelinated fibres to noxious stimuli","volume":"32","author":"Bessou, P.; Perl, E.R.","year":"1969","unstructured":"Bessou P, Perl ER. Response of cutaneous sensory units with unmyelinated fibres to noxious stimuli. J Neurophysiol 1969; 32: 1025-43.","journal-title":"J Neurophysiol"}],"container-title":["Gut"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/gut.33.5.580","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T08:01:04Z","timestamp":1765008064000},"score":1,"resource":{"primary":{"URL":"https:\/\/gut.bmj.com\/lookup\/doi\/10.1136\/gut.33.5.580"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1992,5]]},"references-count":36,"journal-issue":{"issue":"5","published-online":{"date-parts":[[1992,5,1]]},"published-print":{"date-parts":[[1992,5]]}},"alternative-id":["10.1136\/gut.33.5.580"],"URL":"https:\/\/doi.org\/10.1136\/gut.33.5.580","relation":{},"ISSN":["0017-5749","1468-3288"],"issn-type":[{"type":"print","value":"0017-5749"},{"type":"electronic","value":"1468-3288"}],"subject":[],"published":{"date-parts":[[1992,5]]}}}