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13-09-2009 | Gastroenterology | Article

Non-cardiac chest pain has different characteristics to GERD

Abstract

Free abstract

MedWire News: Non-cardiac chest pain (NCCP) has different clinical characteristics to gastroesophageal reflux disease (GERD) although both have a similar benign prognosis, researchers report.

NCCP lacked the typical esophageal reflux found with GERD and cardiac factors were more common with the former, the US researchers report.

The team, from Hines Veterans Affairs Hospital in Illinois, adds: “Whatever the cause of NCCP, the diagnosis itself seems to be fleeting.”

The source of most cases of NCCP is thought to be in the esophagus, say Stephen Sontag and colleagues.

They studied whether NCCP and GERD were really different manifestations of the same underlying abnormality among patients seen at their institution between 1984 and 1996.

During the 12-year period, 1218 patients with GERD were referred for endoscopy, as were 161 with NCCP, who were referred after negative coronary angiography.

The groups were mostly similar, but a greater proportion of people in the NCCP group were Black. Mean follow-up was 9.8 years.

NCCP patients had a significantly lower prevalence of GERD-related findings such as endoscopic esophagitis, Barrett’s metaplasia, the development of esophageal adenocarcinoma, and hiatal hernia.

There was a higher prevalence of coronary artery disease in NCCP versus GERD patients, and a trend toward greater cardiac clinic enrollment and use of cardiac medication. The NCCP group also used less anti-GERD therapy, and for a significantly shorter time.

However, there was no significant difference in survival between the groups, and the NCCP diagnosis disappeared from the electronic hospital record in 96% of patients within 2 years of follow-up.

The researchers conclude in the American Journal of Gastroenterology: “Although NCCP seems to be a transient diagnosis that disappears from the medical record shortly after the initial diagnosis, patients with NCCP or GERD have similar long-term benign outcomes, as there is likely a subset that are typically GERD.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

By Anita Wilkinson