Diagnosing Gastroenterological Causes of Noncardiac Chest Pain

Endoscopy and pH tests should be used to confirm GERD status to guide decisions on treatment with PPIs and the need for further diagnostic testing.

The evaluation of patients with noncardiac chest pain commonly focuses on gastroesophageal reflux disease (GERD) or esophageal dysmotility as possible etiologies. Although many caregivers frequently use empiric treatment with proton-pump inhibitor (PPI) therapy to diagnose GERD as the cause of noncardiac chest pain, it is unclear whether a positive response is definitive.

To investigate this issue, researchers conducted a systematic literature review and identified six randomized controlled trials that reported response of chest pain (with negative cardiac evaluation) to PPI therapy versus placebo. In five of the six trials, PPIs were taken twice daily. Objective evidence of GERD was defined by either abnormal pH monitoring or endoscopic evi…

Reviewing Author

David A. Johnson, MD

Disclosures

Consultant/Advisory boardMedscape/WebMD; Pfizer; CRH Medical Corporation; Aries

EquityCRH Medical Corporation

Editorial boardsMedscape Gastroenterology

Leadership positions in professional societiesAmerican College of Gastroenterology Research Institute Board of Directors