Diagnosis and Treatment of Patients With Gastroesophageal Reflux and Noncardiac Chest Pain

Wg, Stahl; Rr, Beton; Cs, Johnson; Cl, Brown; Jp, Waring

doi:10.1097/00007611-199407000-00013

Cited by 45 publications

(23 citation statements)

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“…In an open-label study, Stahl et al have demonstrated that high-dose H 2 blocker therapy was required for the treatment of GERD-related NCCP in 13 patients, of whom 7 had previously failed to respond to a conventional dose of H 2 blocker (17).…”

Section: Nccp Is a Common Clinical Problemmentioning

confidence: 99%

Attitudes and Referral Patterns of Primary Care Physicians When Evaluating Subjects with Noncardiac Chest Pain?A National Survey

et al. 2005

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Noncardiac chest pain (NCCP) may affect up to 23% of the U.S. population. The clinical approach and referral patterns of primary care physicians (PCPs) when evaluating NCCP subjects are unknown. We aimed to determine the preferences of diagnostic tests, referral patterns, and treatment plans of NCCP patients by PCPs. PCPs were randomly selected from the American Medical Association national membership list. A 24-item questionnaire was mailed, which focused on demographic information, characteristics of practice, preferences of diagnostic tests, referral patterns, and treatment plans. Two hundred five (40%) PCPs returned the questionnaire (mean age, 49; 77% males; practice type--community-based, 40.5%; hospital-based, 10.7%; and combined, 47.3%; physician type--internists, 46.3%; family physicians, 44.4%; general practitioners, 4.9%; and others, 2.9%). The mean number of NCCP patients seen in the past 6 months was 108 (6.4% of total patients) and 79.5% were treated primarily by PCPs. The three most common diagnostic tests used were empirical proton pump inhibitor (PPI) trial (45.6%), chest radiograph (39.9%), and upper endoscopy (18.7%). Most PCPs reported that they are either comfortable (44.6%) or very comfortable (21.2%) in diagnosing NCCP. The three most commonly used therapeutic modalities for NCCP were PPIs (37.8%), lifestyle modification (33.7%), and H2 blockers (12.4%). Of those NCCP patients referred to a subspecialist, most ended up in gastroenterology (75.6%), followed by cardiology (7.8%) and pulmonary (1.6%) clinics. We conclude that most PCP's diagnose and treat NCCP patients without referring them to a gastroenterologist. However, diagnostic and treatment strategies may not follow the current understanding and knowledge of the disorder.

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Section: Nccp Is a Common Clinical Problemmentioning

confidence: 99%

Attitudes and Referral Patterns of Primary Care Physicians When Evaluating Subjects with Noncardiac Chest Pain?A National Survey

et al. 2005

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“…Stahl et al found that Ranitidine in 13 patients improved chest pain in all the patients after eight weeks treatment [19]. Achem et al [20] demonstrated that in patients with nutcracker oesophagus reducing oesophageal acid exposure using either omeprazole or ranitidine and found positive results [20].…”

Section: Treatment Of Gord In Nccpmentioning

confidence: 99%

Non Cardiac Chest Pain (NCCP)

Js¹,

Whorwell²

2016

GHOA

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Non-cardiac chest pain (NCCP) is a common clinical problem however the pathophysiology remains poorly understood. Until the pathophysiology is more clearly understood, certain patients with NCCP continue to experience chest pain and seek frequent medical attention. This mini-review will discuss the underlying pathophysiology of NCCP including gastro-oesophageal reflux, oesophageal dysmotility and visceral hypersensitivity. Furthermore, it aims to highlight the current treatment options based on the current literature.

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“…These studies involved few patients, and none were placebo controlled [34,38,39]. The importance of GER was underscored during an open-label trial of acid suppressive medications in patients with abnormal esophageal motility (nutcracker esophagus) and coexisting GER on pH testing.…”

Section: The Role Of Esophageal Refluxmentioning

confidence: 99%

Recent developments in chest pain of undetermined origin

Achem

2000

Curr Gastroenterol Rep

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The syndrome of angina-like pain with normal epicardial coronary vessels is a very common and expensive clinical problem. Patients suffering from this condition frequently present a diagnostic challenge. Cardiac and musculoskeletal disorders must be excluded prior to identifying the esophagus as the source of pain. The term "chest pain of undetermined origin" (UCP) has been proposed to refer to this condition. Esophageal dysmotility was previously considered a major source for chest pain; however, recent studies indicate that esophageal reflux is the most common cause of esophageal pain. Two controlled trials of acid suppressive agents in patients with chest pain have shown that omeprazole provides effective pain relief for the majority of these individuals. Visceral hyperalgesia and psychologic disturbances are also commonly noted in patients with UCP. Much remains to be learned about the etiology of visceral hyperalgesia and the precise role of psychologic abnormalities in these patients. Until further information is available, treatment with imipramine or trazodone has been shown to offer effective relief of chest pain for subgroups of patients with UCP. Psychologic intervention is also valuable in the management of some patients. Studies of other therapeutic regimens continue to be conducted.

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Diagnosis and Treatment of Patients With Gastroesophageal Reflux and Noncardiac Chest Pain

Cited by 45 publications

References 0 publications

Attitudes and Referral Patterns of Primary Care Physicians When Evaluating Subjects with Noncardiac Chest Pain?A National Survey

Attitudes and Referral Patterns of Primary Care Physicians When Evaluating Subjects with Noncardiac Chest Pain?A National Survey

Non Cardiac Chest Pain (NCCP)

Recent developments in chest pain of undetermined origin

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