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Gastroenterol Hepatol. 2014 Oct;37(8):452-61. doi: 10.1016/j.gastrohep.2014.02.009. Epub 2014 Apr 13.

[What is the utility of proton pump inhibitor testing in non-cardiac chest pain?].

[Article in Spanish]

Author information

  • 1Servicio de Aparato Digestivo y Endoscopia, Hospital General de Catalunya, UIC, Sant Cugat del Vallès, Barcelona, España.
  • 2Servicio de Cardiología, Hospital General de Catalunya, Sant Cugat del Vallès, Barcelona, España.
  • 3Departamento de Ciencias Experimentales y de la Salud, Facultad de Ciencias de la Salud y de la Vida, Universitat Pompeu Fabra, Barcelona, España.
  • 4Servicio de Aparato Digestivo y Endoscopia, Hospital General de Catalunya, UIC, Sant Cugat del Vallès, Barcelona, España. Electronic address: esapfra@gmail.com.

Abstract

BACKGROUND AND AIMS:

Noncardiac chest pain (NCCP) often represents a diagnostic and therapeutic challenge. Given that gastroesophageal reflux disease (GERD) is the most common cause of NCCP, initial treatment with proton-pump inhibitors (PPI) has been proposed for all patients (PPI testing), reserving esophageal function testing solely for non-responders. The aim of the present study was to provide evidence on the clinical utility of PPI testing with high-dose pantoprazole in patients with NCCP.

PATIENTS AND METHODS:

We carried out a study of diagnostic performance with a cohort design in patients with NCCP, who had been assessed by the Cardiology Service. All patients underwent upper endoscopy, esophageal manometry, and 24h esophageal pH monitoring before PPI testing with pantoprazole 40 mg every 12h for 1 month. Before and after treatment, we assessed the severity (intensity and frequency) of chest pain, quality of life, and anxiety and depression by means of specific questionnaires. The diagnosis of GERD was based on a pathological finding of esophageal pH monitoring. A positive response to PPI testing was defined as an improvement in chest pain >50% compared with the baseline score after 1 month of PPI therapy.

RESULTS:

We included 30 consecutive patients (17 men/13 women) with a mean age of 49 years. Of these 30 patients, 20 with NCCP had GERD (67%, 95%CI: 47%-83%). A positive response to PPI therapy was observed in 13 of the 30 (43%) patients with NCCP: 11 of the 20 (55%) patients in the GERD-positive group and 2 of the 10 (20%) in the GERD-negative group. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of PPI testing was 55%, 80%, 85%, 47% and 63%, respectively. A significant reduction in chest pain after pantoprazole therapy (P=.003) and a slight non significant improvement in anxiety and depression was achieved in the GERD-positive group as compared to the GERD-negative group.

CONCLUSIONS:

In NCCP, PPI testing with pantoprazole has a low sensitivity for the diagnosis of GERD, placing in doubt the strategy of reserving functional study to non-responders to antisecretory therapy. Esophageal function testing and accurate diagnosis would allow appropriate targeted therapy for all patients with NCCP.

Copyright © 2013 Elsevier España, S.L.U. and AEEH y AEG. All rights reserved.

KEYWORDS:

Dolor torácico no cardíaco; Enfermedad por reflujo gastroesofágico; Gastroesophageal reflux disease; Noncardiac chest pain; Test de inhibidores de la bomba de protones; Testing proton-pump inhibitors

PMID:
24725608
[PubMed - in process]
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