Noncardiac Chest Pain—An Asia-Pacific Survey on the Views of Primary Care Physicians

Shin

Pediatr Gastroenterol Hepatol Nutr

et al. 2015

PurposePediatric chest pain is considered to be idiopathic or caused by benign diseases. This study was to find out how much upper gastrointestinal (UGI) diseases are major causes of chest pain in pediatric patients.MethodsThe records of 75 children (42 boys and 33 girls, aged 3-17 years old) who have presented with mainly chest pain from January 1995 to March 2015 were retrospectively reviewed. Chest X-ray and electrocardiography (ECG) were performed in all aptients. Further cardiologic and gastrointestinal (GI) evaluations were performed in indicated patients.ResultsChest pain was most common in the children of 6 and 9 to 14 years old. Esopha-gogastric diseases were unexpectedly the most common direct causes of the chest pain, the next are idiopathic, cardiac diseases, chest trauma, respiratory disease, and psychosomatic disease. Even though 21 showed abnormal ECG findings and 7 showed abnormalities on echocardiography, cardiac diseases were determined to be the direct causes only in 9. UGI endoscopy was performed in 57 cases, and esophago-gastric diseases which thereafter were thought to be causative diseases were 48 cases. The mean age of the children with esophago-gastric diseases were different with marginal significance from that of the other children with chest pain not related with esophago-gastric diseases. All the 48 children diagnosed with treated with GI medicines based on the diagnosis, and 37 cases (77.1%) subsequently showed clinical improvement.ConclusionDiagnostic approaches to find out esophageal and gastric diseases in children with chest pain are important as well as cardiac and respiratory investigations.

Section: Discussionmentioning

confidence: 75%

The Importance of Esophageal and Gastric Diseases as Causes of Chest Pain

Shin

Pediatr Gastroenterol Hepatol Nutr

et al. 2015

“…Some authors have reported a positive association between Hp infection, especially with CagA-positive strains and cardiac syndrome X [19, 20], and acute coronary syndromes [13, 14], although some have not confirmed this [21, 22, 31]. Moreover, the majority of physicians working in the Asia-Pacific region believe that Helicobacter pylori plays a role in NCCP pathogenesis [32]. The eradication of Hp, similarly to my study, was an effective treatment for patients with reflux-related NCCP after a 12-month follow-up [33].…”

Section: Discussionmentioning

confidence: 99%

The favourable effect of Helicobacter pylori eradication therapy in patients with recurrent angina-like chest pain and non-responsive to proton pump inhibitors – a preliminary study

Budzyński¹

2011

aoms

IntroductionThe outcome of Helicobacter pylori (Hp) eradication therapy from the aspect of prevention of chest pain recurrence is still uncertain. The aim of this study was to assess the influence of Hp eradication therapy on the risk of hospitalization due to acute coronary syndrome.Material and methodsThe analysis was carried out in 63 consecutive patients with recurrent retrosternal symptoms: 28 (44%) with significant coronary artery narrowing in coronarography not qualified for revascularization by an invasive cardiologist, and 35 (56%) with no obstructive coronary artery lesions. In 33 (52%) of the patients, Hp infection was found and standard eradication therapy with omeprazole (2 × 20 mg), amoxicillin (2 × 1 g) and metronidazole (2 × 500 mg) was recommended. The mean follow-up period was 977 ±249 days.ResultsChest pain requiring hospitalization because of unstable angina within the follow-up period was observed in 9 (27%) of the Hp-infected individuals and in 15 (50%) subjects in whom a urease test and histology did not confirm this infection (p = 0.055). The recommendation of Hp-eradication treatment was a significant factor prolonging the hospitalization-free period, both in the two Kaplan-Meier curve analyses (Cox’s F test = 1.96; p = 0.049) and the Cox proportional hazard model (beta = –1.18; p = 0.045), but was weaker than the effect of the non-obstructive coronary angiogram (beta = –1.45; p = 0.03).ConclusionsThe recommendation of Hp-eradication therapy may prolong the hospitalization-free period for patients with recurrent chest pain.

“…Guidelines on the management of H. pylori infection in different clinical situations have been published and are being periodically revised[ 3,9,10,11]. Previous studies found that these guidelines were not always followed by physicians [12,13,14,15,16,17,18,19,20,21,22]. Knowing the factors that affect their practice on H. pylori infection may facilitate appropriate education among frontline practitioners.…”

Section: Introductionmentioning

confidence: 99%

Factors Affecting Physicians’ Practices Related to <i>Helicobacter pylori</i> Infection: Effect of Experience and Mode of Practice

Yee¹,

Cheung²,

Gu³

et al. 2008

Digestion

Self Cite

Background: Studies found that guidelines on the management of Helicobacter pylori were not always followed in clinical practice. This study investigated factors that were responsible for the deviation. Methods: A cross-sectional survey using a structured self-administered questionnaire was used to ask physicians whether they would offer testing and treatment for H. pylori infection in different clinical scenarios. Results: 170 medical practitioners completed the questionnaires. Respondents in the private sector were significantly more likely to test and treat than those in the public sector for patients with a history of peptic ulcer, gastric cancer or no symptom (p = 0.018, <0.001 and 0.041, respectively). Significant differences in practice were noted amongst practitioners of different specialty and seniority, but not qualification. Medical practitioners in the private sector complied with the guidelines significantly better than those in the public sector (p = 0.002) and so did senior practitioners compared with junior practitioners (p < 0.001). The specialty and qualification of the respondents, however, did not have a significant effect. Conclusion: There were significant differences in the management of H. pylori amongst medical practitioners from the private and public sectors and amongst senior and junior practitioners. Published guidelines were not completely followed. Further educational campaigns are needed.