Clinical usefulness of subgrouping of patients with non‐cardiac chest pain according to characteristic symptoms in Korea

Kim, Jeong Hwan; Rhee, Poong–Lyul; Park, Eunha; Son, Hee Jung; Kim, Jae J; Rhee, Jong Chul

doi:10.1111/j.1440-1746.2006.04264.x

Cited by 32 publications

(35 citation statements)

References 30 publications

(89 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Two further studies compared the accuracy of NCCP and typical GERD symptoms (LR + 2.70 [27], 2.75 [24]; LR- 0.42 [24], 0.78 [27]) with NCCP without GERD symptoms (LR + 0.49; LR- 2.71 [24]) or with NCCP and a history of heart burn (LR + 2.15; LR- 0.74 [27]).…”

Section: Resultsmentioning

confidence: 99%

Diagnostic indicators of non-cardiovascular chest pain: a systematic review and meta-analysis

Wertli

Ruchti

Steurer

et al. 2013

BMC Med

View full text Add to dashboard Cite

BackgroundNon-cardiovascular chest pain (NCCP) has a high healthcare cost, but insufficient guidelines exist for its diagnostic investigation. The objective of the present work was to identify important diagnostic indicators and their accuracy for specific and non-specific conditions underlying NCCP.MethodsA systematic review and meta-analysis were performed. In May 2012, six databases were searched. Hand and bibliography searches were also conducted. Studies evaluating a diagnostic test against a reference test in patients with NCCP were included. Exclusion criteria were having <30 patients per group, and evaluating diagnostic tests for acute cardiovascular disease. Diagnostic accuracy is given in likelihood ratios (LR): very good (LR+ >10, LR- <0.1); good (LR + 5 to 10, LR- 0.1 to 0.2); fair (LR + 2 to 5, LR- 0.2 to 0.5); or poor (LR + 1 to 2, LR- 0.5 to 1). Joined meta-analysis of the diagnostic test sensitivity and specificity was performed by applying a hierarchical Bayesian model.ResultsOut of 6,316 records, 260 were reviewed in full text, and 28 were included: 20 investigating gastroesophageal reflux disorders (GERD), 3 musculoskeletal chest pain, and 5 psychiatric conditions. Study quality was good in 15 studies and moderate in 13. GERD diagnosis was more likely with typical GERD symptoms (LR + 2.70 and 2.75, LR- 0.42 and 0.78) than atypical GERD symptoms (LR + 0.49, LR- 2.71). GERD was also more likely with a positive response to a proton pump inhibitor (PPI) test (LR + 5.48, 7.13, and 8.56; LR- 0.24, 0.25, and 0.28); the posterior mean sensitivity and specificity of six studies were 0.89 (95% credible interval, 0.28 to 1) and 0.88 (95% credible interval, 0.26 to 1), respectively. Panic and anxiety screening scores can identify individuals requiring further testing for anxiety or panic disorders. Clinical findings in musculoskeletal pain either had a fair to moderate LR + and a poor LR- or vice versa.ConclusionsIn patients with NCCP, thorough clinical evaluation of the patient’s history, symptoms, and clinical findings can indicate the most appropriate diagnostic tests. Treatment response to high-dose PPI treatment provides important information regarding GERD, and should be considered early. Panic and anxiety disorders are often undiagnosed and should be considered in the differential diagnosis of chest pain.

show abstract

Section: Resultsmentioning

confidence: 99%

Diagnostic indicators of non-cardiovascular chest pain: a systematic review and meta-analysis

Wertli

Ruchti

Steurer

et al. 2013

BMC Med

View full text Add to dashboard Cite

show abstract

“…Chest pain is reported by 37-37.6% of patients with frequent heartburn symptoms, compared with 28.3-30.7% of those with infrequent pyrosis and 7.9-12.2% of people without GERD symptoms [9,61]. In a recent study, Kim et al [62] demonstrated by endoscopy, manometry, and 24-h esophageal pH-metry that typical reflux symptoms can be used to distinguish patients with GERD-related NCCP from patients with NCCP unrelated to reflux, whereas erosive changes in the esophageal mucosa do not. In fact, the incidence of erosive esophagitis in patients with GERD-related NCCP has been reported to be as low as 10%, which makes this procedure relatively useless in the evaluation of these patients [63].…”

Section: Resultsmentioning

confidence: 96%

The Italian validation of the Montreal Global definition and classification of gastroesophageal reflux disease

Pace

Bazzoli

Fiocca

et al. 2009

European Journal of Gastroenterology & Hepatology

View full text Add to dashboard Cite

show abstract

“…In addition, NCCP patients with typical reflux symptoms are more likely to have GERD-related NCCP than those without typical reflux symptoms. 30 Accordingly, empirical PPI treatment is a cost-effective diagnostic strategy in NCCP patients with typical reflux symptoms.…”

Section: Ppi Test Can Be Used To Confirm the Diagnosis Of Gerd-relatementioning

confidence: 99%

“…38,39 However, the relationship between these abnormal motilities and chest pain remains unclear and specific esophageal motility disorders such as achalasia and nutcracker esophagus, and diffuse esophageal spasm are found in only a minority of patients. 30,38,39 Likewise, the American Gastroenterological Association guidelines on esophageal manometry state that manometry is not indicated as the initial test for chest pain because of the low specificity of the findings and the low likelihood of detecting a clinically significant motility disorder. 37 However, manometry could detect achalasia, jackhammer esophagus or nutcracker esophagus, and distal esophageal spasm that could explain the patient's chest pain.…”

Section: Esophageal Manometry Could Be Helpful In the Evaluation Of Nccpmentioning

confidence: 99%

Noncardiac Chest Pain: Update on the Diagnosis and Management

Rhee

2015

Korean J Gastroenterol

Self Cite

View full text Add to dashboard Cite

Noncardiac chest pain (NCCP) is defined as recurring, angina-like, retrosternal chest pain of noncardiac origin. Although patients with NCCP have excellent long-term prognosis, most suffer persistently from their symptoms. Several pathophysiological mechanisms have been suggested, including gastroesophageal reflux disease (GERD), esophageal motility disorder, esophageal hypersensitivity, and psychological comorbidity. Among them, GERD is the most common cause of NCCP. Therefore, GERD should first be considered as the underlying cause of symptoms in patients with NCCP. Empirical proton pump inhibitor (PPI) treatment with a preferably double dose for more than 2 months could be cost-effective. PPI test can also be used for diagnosis of GERD-related NCCP, but it should be considered for patients with NCCP occurring at least weekly and its duration should be at least 2 weeks. However, upper endoscopy and esophageal pH monitoring are necessary when the diagnosis of GERD is uncertain. Esophageal impedance-pH monitoring could further improve the diagnostic yield. Patients with GERD-related NCCP should preferably be treated with a double dose PPI until symptoms remit (may require more than 2 months of therapy for optimal symptom control), followed by dose tapering to determine the lowest PPI dose that can control symptoms. However, treatment of patients with non-GERD−related NCCP is challenging. An empirical treatment of antidepressants could be considered. If there are specific esophageal motility disorders, smooth muscle relaxants or endoscopic treatment may be considered in selected cases. If none of these traditional treatments is effective, a psychology consultation for cognitive behavioral therapy should be considered. (Korean J Gastroenterol 2015;65:76-84) Key Words: Diagnosis; Gastroesophageal reflux disease; Noncardiac chest pain (NCCP); Therapy CC This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

show abstract

Clinical usefulness of subgrouping of patients with non‐cardiac chest pain according to characteristic symptoms in Korea

Abstract: Typical reflux symptoms can be used to distinguish patients with GERD-related NCCP from patients with NCCP, and subgrouping according to characteristic symptoms may assist the diagnosis of these patients in Korea.

Cited by 32 publications

References 30 publications

Diagnostic indicators of non-cardiovascular chest pain: a systematic review and meta-analysis

Diagnostic indicators of non-cardiovascular chest pain: a systematic review and meta-analysis

The Italian validation of the Montreal Global definition and classification of gastroesophageal reflux disease

Noncardiac Chest Pain: Update on the Diagnosis and Management

Contact Info

Product

Resources

About