Noncardiac Chest Pain in Young Patients

TO TH E ED ITO R: Noncardiac chest pain (NCCP) is not only a difficult disorder to define but also a heterogenous disorder with many potential causes. Gastroesophageal reflux disease (GERD) represents as one of the most common gastroenterologic causes of NCCP. Seo et al suggested that the prevalence of GERD was 30 percent in young patients with NCCP. In addition, the proton pump inhibitor (PPI) test was very predictable in diagnosing GERD-related NCCP in young patients. There has been a little report of young aged NCCP in spite of the fact that the young age is one of the potential risk factors for NCCP. In the previous report, the authors studied the effective duration of PPI test in NCCP. Among the 42 patients with NCCP, 38% were diagnosed with GERD by endoscopy and 24-hour esophageal pH monitoring. It might be necessary to clarify typical reflux symptoms (regurgitation and reflux) and clinical judgment of the other causes of NCCP, for the reason that the presence of other reflux symptoms is important in diagnosing GERD even in young patients. Furthermore, there are many possible gastroenterologic causes in the differential diagnosis of NCCP as well, for examples; esophageal motility disorder, hepatitis, peptic ulcer disease, biliary colic, splenomegaly, etc. In addition, it might be important to show how the GERD unrelated NCCP patients manage clinically. Recently, a study regarding long-term natural history of NCCP and comparison with GERD has been reported. NCCP patients have a significantly lower prevalence of GERD-related findings such as endoscopic esophagitis (p < 0.0001), Barrett’s metaplasia (p = 0.02), development of esophageal adenocarcinoma and presence of hiatal hernia (p = 0.0001), and the amount and duration of anti-GERD therapy were significantly less in the NCCP group. The diagnosis of NCCP disappeared from the electronic hospital record in 96% of patients within 2 years of follow-up. That is, patients with NCCP, confirmed by the absence of angiogram-documented coronary artery disease had a long-term benign prognosis. According to their 2 studies, the response of PPI test in young NCCP patients (lansoprazole, 30 mg twice a day for 14 days) was similar and effective to that in average aged NCCP patients. Therefore, an empiric PPI test might be necessary for the diagnosis and management of NCCP patients.