Clinically distinct characteristics in patients younger than 40 years old with non‐cardiac chest pain

Ko, Soon Young; Kim, So-I; Kim, Jeong Hwan; Lee, Jung Hyeon; Lee, Kyung‐Ju; Hong, Sung Noh; Lee, Sun-Young; Sung, In‐Kyung; Park, Hyung Seok; Shim, Chan Sup

doi:10.1111/j.1440-1746.2012.07174.x

Cited by 6 publications

(4 citation statements)

References 21 publications

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“…Also a trial of proton pump inhibitor for 2 weeks had a sensitivity of 0.89 (CI: 0.28–1) and specificity of 0.88 (CI: 0.26–1) for GERD as the cause. 9,10 In our study, GERD patients presented similarly to other patients apart from experiencing more nausea. Interestingly, only one-third of them were on an acid-suppressant medication.…”

Section: Discussionsupporting

confidence: 65%

Prevalence and Overlap of Noncardiac Conditions in the Evaluation of Low-risk Acute Chest Pain Patients

Al‐Ani

Winchester²

2015

Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine

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Background When patients present to the emergency department with a complaint concerning for heart disease, this often becomes the primary focus of their evaluation. While patients with noncardiac causes of chest pain outnumber those with cardiac causes, noncardiac etiologies are frequently overlooked. We investigated symptoms and noncardiac conditions in a cohort of patients with chest pain at low risk of cardiac disease. Methods We analyzed data from a prospective registry of patients who were evaluated in our chest pain evaluation center. Registry participants completed standardized and validated instruments for depression (by Patient Health Questionnaire PHQ-9), anxiety (by Generalized Anxiety Disorder GAD-7), and Gastroesophageal Reflux Disorder (GERD; by GERD Symptom Frequency Questionnaire). Chest pain characteristics were recorded; severity was reported on a 10-point scale. Results A total of 195 patients were included in the investigation. Using the instruments noted above, the prevalence of depression was 34%, anxiety was 30%, and GERD was 44%, each of at least moderate severity. 32.5% of patients had 2 or more conditions. The median for the severity of angina was 7/10 and the number of episodes over the preceding week was 2, respectively. Severity of angina was associated with PHQ-9 (r = 0.238; P < 0.001) and GAD-7 (r = 0.283; P < 0.001) scores. The number of angina episodes over the prior week correlated with GERD Symptom Frequency Questionnaire (r = 0.256; P < 0.001) and PHQ-9 (r = 0.175; P = 0.019) scores. No correlation was observed between any of the scores and body mass index, smoking tobacco, diabetes mellitus, hypertension, or hyperlipidemia. Conclusion In our cohort of low-risk acute chest pain patients, depression, anxiety, and GERD were common, substantial overlap was observed. The severity of these noncardiac causes of chest pain causes correlated with the self-reported severity and frequency of angina, but weakly. These conditions should be part of a comprehensive plan of care for chest pain management.

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Section: Discussionsupporting

confidence: 65%

Prevalence and Overlap of Noncardiac Conditions in the Evaluation of Low-risk Acute Chest Pain Patients

Al‐Ani

Winchester²

2015

Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine

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“…En conjunto, se reportó una sensibilidad del 42%-94% y una especificidad del 25%-89%. 47,[50][51][52][53][54][55][56][57][58][59] (Tabla 4).…”

Section: ¿Se Recomienda La Prueba Terapéutica Con Ibp Empírica Para E...unclassified

“…En Corea, se evaluó en un estudio la utilidad diagnóstica del lansoprazol 30 mg día versus placebo por 14 días, en 90 pacientes clasificados en dos grupos de edad: mayores y menores de 40 años. 56 El 23% de los pacientes jóvenes y el 38% de los mayores de 40 años tuvieron diagnóstico de DTNC relacionado con ERGE basado en la presencia de EE en la EGD o en una pH-metría anormal (p = 0,144). La prueba con IBP mejoró los síntomas significativamente en el grupo con ERGE versus el grupo sin ERGE, independientemente del grupo etario.…”

Section: ¿Se Recomienda La Prueba Terapéutica Con Ibp Empírica Para E...unclassified

Consenso latinoamericano de diagnóstico de la enfermedad por reflujo gastroesofágico

Olmos

Pandolfino

Piskorz

et al. 2022

ACTA

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La enfermedad por reflujo gastroesofágico (ERGE) es sumamente prevalente en nuestro medio. Sus síntomas son variados y los mecanismos fisiopatológicos son múltiples. Por lo tanto, el diagnóstico de esta entidad suele ser complejo. Han sido descriptos una serie de métodos diagnósticos. No obstante, el patrón de oro continúa siendo el tiempo de exposición ácida, medido durante el monitoreo ambulatorio de reflujo a través de pH-metría. El objetivo de este primer consenso latinoamericano fue evaluar críticamente, sobre la base de las mejores evidencias disponibles a la fecha, los diferentes métodos diagnósticos propuestos para la ERGE y emitir recomendaciones consensuadas luego de la discusión entre un grupo de expertos y una votación. Este consenso fue desarrollado por un grupo de expertos a partir de una búsqueda sistemática de la literatura y utilizando la metodología GRADE (Grading of Recommendations Assessment, Development and Evaluation) para la evaluación de la calidad de la evidencia y la decisión de la fuerza de recomendación. Se emitieron recomendaciones en cuanto a la utilidad de diferentes métodos diagnósticos en relación con la ERGE.

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“…The quantitative analysis included 11 studies evaluating the PPI test compared to AET to diagnose GERD in patients with NCCP, yielding a sensitivity of 42%-94% and specificity of 25%-89% 41,[44][45][46][47][48][49][50][51][52][53] (Table S4). The risk of bias was high due to small sample sizes, high heterogeneity, and considerable differences in design, PPI dose and treatment length.…”

Section: Introductionmentioning

confidence: 99%

Latin American consensus on diagnosis of gastroesophageal reflux disease

Olmos,

Pandolfino,

Piskorz

et al. 2024

Neurogastroenterology Motil

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BackgroundDiagnosing gastroesophageal reflux disease (GERD) can be challenging given varying symptom presentations, and complex multifactorial pathophysiology. The gold standard for GERD diagnosis is esophageal acid exposure time (AET) measured by pH‐metry. A variety of additional diagnostic tools are available. The goal of this consensus was to assess the individual merits of GERD diagnostic tools based on current evidence, and provide consensus recommendations following discussion and voting by experts.MethodsThis consensus was developed by 15 experts from nine countries, based on a systematic search of the literature, using GRADE (grading of recommendations, assessment, development and evaluation) methodology to assess the quality and strength of the evidence, and provide recommendations regarding the diagnostic utility of different GERD diagnosis tools, using AET as the reference standard.Key ResultsA proton pump inhibitor (PPI) trial is appropriate for patients with heartburn and no alarm symptoms, but nor for patients with regurgitation, chest pain, or extraesophageal presentations. Severe erosive esophagitis and abnormal reflux monitoring off PPI are clearly indicative of GERD. Esophagram, esophageal biopsies, laryngoscopy, and pharyngeal pH monitoring are not recommended to diagnose GERD. Patients with PPI‐refractory symptoms and normal endoscopy require reflux monitoring by pH or pH‐impedance to confirm or exclude GERD, and identify treatment failure mechanisms. GERD confounders need to be considered in some patients, pH‐impedance can identify supragrastric belching, impedance‐manometry can diagnose rumination.ConclusionsErosive esophagitis on endoscopy and abnormal pH or pH‐impedance monitoring are the most appropriate methods to establish a diagnosis of GERD. Other tools may add useful complementary information.

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Clinically distinct characteristics in patients younger than 40 years old with non‐cardiac chest pain

Cited by 6 publications

References 21 publications

Prevalence and Overlap of Noncardiac Conditions in the Evaluation of Low-risk Acute Chest Pain Patients

Prevalence and Overlap of Noncardiac Conditions in the Evaluation of Low-risk Acute Chest Pain Patients

Consenso latinoamericano de diagnóstico de la enfermedad por reflujo gastroesofágico

Latin American consensus on diagnosis of gastroesophageal reflux disease

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