Pathological bolus exposure plays a significant role in eliciting non‐cardiac chest pain

Kim, Beom Jin; Choi, Sung C.; Kim, Jae J; Rhee, Jong Chul; Rhee, Poong‐Lyul

doi:10.1111/j.1440-1746.2010.06415.x

Cited by 17 publications

(8 citation statements)

References 22 publications

(44 reference statements)

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“…Pathological findings on MII-pH monitoring were identified in almost half (53%) of our NERD patients based on BET, although lesser number of abnormal patients (43%) was recognized when the abnormality was detected on the basis of number of distal refluxes. In agreement with other studies, 17,18 we also believe that in PPI-refractory NERD patients BET values are more reliable than the number of distal refluxes because BET accounts for the total number and duration of acid and non-acid refluxes. In our study, the mean total EAET was 0.84% on 20 mg omeprazole twice daily.…”

Section: Discussionsupporting

confidence: 77%

Diagnostic Utility of Impedance-pH Monitoring in Refractory Non-erosive Reflux Disease

Khan

Alaraj

Alsohaibani

et al. 2014

J Neurogastroenterol Motil

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Background/Aims Approximately one-third of non-erosive reflux disease (NERD) patients are refractory to proton pump inhibitors (PPI) and face a therapeutic challenge. Therefore, it is important to differentiate between pathological and non-pathological reflux utilizing multichannel intraluminal impedance-pH (MII-pH) to analyze symptom-reflux association and diagnose true NERD versus hyper-sensitive esophagus (HE) and functional heartburn (FH). Herein, we evaluated the diagnostic yield of MII-pH in refractory NERD and sub-classified it based on quantity and quality of acid/non-acid reflux and reflux-symptom association. Methods Sixty symptomatic NERD patients on twice daily PPI for > 2 months were prospectively evaluated by MII-pH. Distal and proximal refluxes, bolus exposure time (BET), esophageal acid exposure time, symptom index (SI) and symptom association probability (SAP) were measured. Results Thirty-two (53%) patients had BET > 1.4% (MII-pH positive-true NERD), while 28 (47%) had BET < 1.4% (MII-pH negative NERD) where SI and SAP were negative in 15/60 (25%; categorized as FH) and SI or SAP were positive in 13/60 (22%; identified as HE). Thirty-eight (63%) patients reported significant SI or SAP parameters where > 80% of symptoms were associated with non-acid reflux. The number of distal refluxes in true NERD versus FH or HE were significantly different, but not between FH and HE. Conclusions Approximately 60% of refractory PPI NERD patients had positive reflux-symptom association, primarily due to non-acid reflux. Nearly half of NERD patients on PPI had normal MII-pH monitoring, sub-divided further into FH and HE equally.

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Section: Discussionsupporting

confidence: 77%

Diagnostic Utility of Impedance-pH Monitoring in Refractory Non-erosive Reflux Disease

Khan

Alaraj

Alsohaibani

et al. 2014

J Neurogastroenterol Motil

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“…[16,17] A range of 22% to 80% of those with NCCP had pathological acid reflux on 24-hour esophageal pH monitoring. [18] The major reflux symptoms, including heartburn, acid regurgitation, and dysphagia, were negatively related to the mental and physical QoL. Besides, extraesophageal symptoms and FD were also an important factors influence on the mental aspect of QoL in NCCP patients, which frequently overlapped with GERD [19] and existed in 36.5% and 37.5% of NCCP subjects, respectively.…”

Section: Discussionmentioning

confidence: 99%

Psychological distress as a crucial determinant for quality of life in patients with noncardiac chest pain in Central China

Zhang

Tu²,

Chen³

et al. 2016

Medicine

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Increased psychiatric comorbidity, predominantly anxiety and depressive symptoms, and lower quality of life (QoL) are associated with noncardiac chest pain (NCCP). We aimed to investigate the roles of anxiety and depression in the impaired QoL of NCCP patients in Central China.In this hospital-based cross-sectional study, 200 consecutive patients who complained of chest pain with normal coronary angiography were enrolled in the Department of Cardiology and Gastroenterology, Union Hospital, Wuhan, China. Meanwhile, 100 healthy controls, with age and sex-matched, were recruited. Upper gastrointestinal endoscopy was undergone and a standardized symptom questionnaire was completed in NCCP patients. Levels of anxiety and depression and QoL were assessed using locally translated and validated versions of the Hospital Anxiety and Depression Scale (HADS) and the 36-item Short Form Health Survey (SF-36), respectively.The NCCP patients had poorer physical and mental QoL compared with the controls, and nearly half of them had anxiety (49.7%) and depression (40.1%). Those with anxiety and/or depression had lower physical (PCS) and mental (MCS) component summary score compared with those without anxiety and depression. Increased levels of anxiety and depression were associated with lower PCS (r = −0.469 and −0.523 respectively, P < 0.001) and MCS (r = −0.474 and −0.440, respectively, P < 0.001). The chest pain, heartburn, and anxiety were independent factors influence on both PCS and MCS. Moreover, psychological distress, besides directly acting on the QoL, may also mediate indirectly effects of physical symptoms on both the physical and mental QoL.We demonstrated that anxiety and depression are important determinants for the QoL of NCCP patients. Therefore, interventions should emphasize on identifying and treating the psychological impact in NCCP.

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“…They recommended using DEA > 220 mmHg instead of 180 mmHg as the cut-off for diagnosing NE as this would result in better symptom correlation. Kim et al 18 and Jung et al 19 also reported a positive correlation between chest pain and DEA. However, Tsuboi et al 20 reported that patient symptoms of chest pain and dysphagia correlate with LES pressure and not with peak distal esophageal amplitude.…”

Section: Discussionmentioning

confidence: 92%

High‐resolution impedance manometry findings in patients with nutcracker esophagus

Hoshino¹,

Sundaram²,

Juhasz³

et al. 2012

J of Gastro and Hepatol

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Pathological bolus exposure plays a significant role in eliciting non‐cardiac chest pain

Abstract: Combined impedance-pH monitoring improves the detection and characterization of NCCP. This study suggests that pathological bolus exposure plays a major role in eliciting NCCP.

Cited by 17 publications

References 22 publications

Diagnostic Utility of Impedance-pH Monitoring in Refractory Non-erosive Reflux Disease

Diagnostic Utility of Impedance-pH Monitoring in Refractory Non-erosive Reflux Disease

Psychological distress as a crucial determinant for quality of life in patients with noncardiac chest pain in Central China

High‐resolution impedance manometry findings in patients with nutcracker esophagus

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