Clinical characteristics in patients with non-cardiac chest pain could favor gastroesophageal reflux disease diagnosis

BACKGROUND In patients with non-cardiac chest pain (NCCP), gastroesophageal reflux disease (GERD) is thought to be the commonest cause. Ambulatory pH monitoring and/or endoscopy are usually performed in order to confirm GERD diagnosis. At present, clinical diagnosis of reflux in patients with NCCP is uncertain.The aim of the study was to determine clinical characteristics that could identify GERD in patients with NCCP. METHODS A total of 52 (age 52.8±1.8 yrs, 29 women) patients with NCCP underwent combined impedance-pH monitoring and gastroscopy. GERD diagnosis was based on the presence of esophagitis and/or a positive impedance-pH study (symptom index >50% and/or esophageal acid exposure time >4.0%). Patients were then divided into 2 groups: GERD- and non-GERD-related NCCP. Demographic and clinical parameters were compared between these two groups. RESULTS GERD-related NCCP was found in 30 (58%) patients. Demographic characteristics were similar in both groups. Chest pain showed no difference in severity, radiation, relation to exercise and relation to sleep between the two groups. In the GERD-related NCCP group, chest pain was more prevalent during the postprandial period (P<0.05) and was relieved by spontaneous use of antireflux drugs (P<0.05). The presence of typical reflux symptoms favored a GERD diagnosis (P<0.05). CONCLUSIONS A proportion of patients with NCCP showed clinical characteristics suggesting a GERD diagnosis. Typical reflux symptoms, postprandial chest pain and use of anti-reflux drugs for pain relief were the best predictors for GERD-related NCCP.