The view of gastroenterologists on non‐cardiac chest pain in Asia

Abstract

SUMMARY BackgroundNon-cardiac chest pain is an important disorder in Asia. The practice and views of gastroenterologists on non-cardiac chest pain in this region are not known.

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

“…Non‐cardiac chest pain (NCCP) is defined as recurrent episodes of angina‐like retrosternal pain or discomfort in patients without evidence of cardiac disease 1–4 . NCCP is a common disorder and affects one‐quarter of the population in their lifetime 3 . The causes of NCCP are diverse.…”

Is Noncardiac Chest Pain Truly Noncardiac?

“…1,2 Of the numerous causes of NCCP, gastroesophageal reflux disease (GERD)-related NCCP is considered the most prevalent. [3][4][5][6][7][8] Therefore, antireflux drugs-including proton pump inhibitors-have been proven to be effective in the treatment of NCCP. 2,5,[9][10][11] Nonetheless, it has been accepted that NCCP patients have higher rates of recurrence of chest symptoms.…”

Non‐cardiac chest pain in Asia: Time for a consensus

“…had an angiogram, in practice, only 11% of cardiologists in the Asian Pacific region would order an angiogram to exclude cardiac causes in patients presenting with NCCP 5,8 . Amongst gastroenterologists and primary care physicians, the preferred cardiac investigation was resting or treadmill electrocardiogram (ECG) 9,10 . Since cardiac catheterization is not without risks, perhaps utilization of emergent imaging modalities such as multi‐slice computed tomography (CT) angiography could be considered.…”

“…Utilization of the PPI test as both a means of investigation and treatment in NCCP is common in the Asia Pacific region 8–10 . Symptom response from the PPI test has been used to identify GERD in SE Asian patients with NCCP with a sensitivity of 92% and specificity of 67% 15 .…”

“…At present, after the exclusion of cardiac causes, the suggested best test in the evaluation of NCCP is 24‐h esophageal pH monitoring combined with symptom analysis 11–13 . However, in practice, endoscopy, PPI test and chest radiograph were most frequently ordered by cardiologists, gastroenterologists and primary care physicians in the Asia Pacific region 8–10 . pH studies are not frequently utilized in this region.…”