The Value of Clinical Presentation in Diagnosis of Reflux in Noncardiac Chest Pain Patients

Abstract

Background: Non-cardiac chest pain (NCCP) presents as a frequent diagnostic challenge, with patients tending to use a disproportionate level of health care resources. Gastroesophageal reflux disease (GERD) is the most frequent cause of NCCP. Thus the typical symptoms of reflux like Heartburn and regurgitation, when present as predominant symptoms are quite specific for diagnosing GERD patients but in patients with NCCP the clinical diagnos of reflux is difficult and need to utilize invasive methods or omeprazol (PPI) test for its detection. The aim of the study was to evaluate the role of clinical presentation in diagnosing GERD in NCCP patients.

Materials and Methods: NCCP patients underwent upper endoscoy, Bernstein test and short course of omeprazol test. the patients were divided in two groups based on the GER or non-GER related chest pain. In the end, clinical presentation of the patients was compared in two groups. GERD was considered positive as evidences of mucosal injury on upper endoscopy and or Bernstein and PPI tests had been positive together.

Results: From 78 NCCP patients (41 male; mean age 50.4 ± 2.3), the chest pain in 35 patients (44.8 %) were related to GERD. Two groups were the same based on sex and age. The chest pain; severity, site, radiation and relation to food, exercise, and sleep were the same in two groups, except two symptoms; the pain that was relived by anti-acid (p‹0.031) and presence of classical reflux symptoms (p‹0.009) were seen in GERD patients. It was interest that in the history of the patients, heart burn (p‹0.036) and regurgitation (p‹0.002) were seen in patients with GERD-related chest pain.

Conclusions: Clinical examination is important in diagnosing GERD in NCCP. Although the chest pain is the same in reflux and non refluxrelated NCCP, but the symptoms of heartburn or regurgitation in present or recent past history of patients are diagnostic for GERD-related chest pain.