INTRODUCTION: The aetiology of non-cardiac chest-pain (NCCP) is unknown, but previous studies demonstrated that both visceral hyperalgesia to esophageal distension or even chemostimulation with acid reflux (AR) are frequently involved. However, the role of weakly acidic reflux (WAR) in provoking NCCP is poorly known AIMS & METHODS: To assess the role of WAR in a large group of NCCP patients studied using multichannel intraluminal impedance-pH (MII-pH). Consecutive patients complaining of NCCP were studied while on or off-PPI therapy (discontinued PPI >14 days prior to test). They referred to our units for undergoing pre-operative evaluation or in order to be studied due to PPI refractoriness. After upper endoscopy, patients were classified as having erosive reflux disease (ERD), in case of esophageal mucosal breaks, or non-erosive reflux disease (NERD). During MII-pH tracings analysis we measured esophageal acid exposure time (AET), characteristics of reflux episodes (AR/WAR) and symptom-reflux association using both symptom association probability (SAP+ if95%) and symptom index (SI+ if50%). Symptom association was considered positive in case of SAP+ and/or SI+. RESULTS: Out of 354 NCCP patients, 301 (85%) experienced NCCP during the MIIpH test and were further analyzed. Among the 231 off-PPI (127F/104M, mean age 48; 11% ERD/89% NERD), 70 (30%) had an abnormal AET. Out of 161 (70%) with normal AET, a positive SAP/SI was found in 39 (16%) for AR, 23 (10%) for both AR and WAR and 30 (13%) for WAR. Seventy-two patients (31%) patients had no refluxsymptom association. In the group of patients on-PPI (N = 70; 36F/34M, mean age 50; 9% ERD/91% NERD), 9 (13%) had an abnormal AET. Out of 61 (87%) with normal AET, 7 (10%) had a positive SAP for AR, 24 (34%) for WAR and 4 (6%) for both AR and WAR. Twenty-six (37%) patients had no reflux-symptom association. Identifying patients with symptomatic WAR reduces the number of patients with unexplained NCCP from 102 (44%) to 72 (31%) and from 50 (71%) to 28 (37%) among patients off-PPI and on-PPI, respectively (p<0.01). CONCLUSION: Our data emphasize the important role of WAR in provoking NCCP, in particular in patients on acid-suppressive therapy. This further supports the use of MII-pH in the diagnostic algorithm of unexplained chest pain.
IMPEDANCE-PH MONITORING AND SYMPTOM ANALYSIS IN EROSIVE AND NON-EROSIVE REFLUX DISEASE PATIENTS WITH NON-CARDIAC CHEST PAIN − A STUDY ON AND OFF THERAPY
RICCI, Giorgio;
2012
Abstract
INTRODUCTION: The aetiology of non-cardiac chest-pain (NCCP) is unknown, but previous studies demonstrated that both visceral hyperalgesia to esophageal distension or even chemostimulation with acid reflux (AR) are frequently involved. However, the role of weakly acidic reflux (WAR) in provoking NCCP is poorly known AIMS & METHODS: To assess the role of WAR in a large group of NCCP patients studied using multichannel intraluminal impedance-pH (MII-pH). Consecutive patients complaining of NCCP were studied while on or off-PPI therapy (discontinued PPI >14 days prior to test). They referred to our units for undergoing pre-operative evaluation or in order to be studied due to PPI refractoriness. After upper endoscopy, patients were classified as having erosive reflux disease (ERD), in case of esophageal mucosal breaks, or non-erosive reflux disease (NERD). During MII-pH tracings analysis we measured esophageal acid exposure time (AET), characteristics of reflux episodes (AR/WAR) and symptom-reflux association using both symptom association probability (SAP+ if95%) and symptom index (SI+ if50%). Symptom association was considered positive in case of SAP+ and/or SI+. RESULTS: Out of 354 NCCP patients, 301 (85%) experienced NCCP during the MIIpH test and were further analyzed. Among the 231 off-PPI (127F/104M, mean age 48; 11% ERD/89% NERD), 70 (30%) had an abnormal AET. Out of 161 (70%) with normal AET, a positive SAP/SI was found in 39 (16%) for AR, 23 (10%) for both AR and WAR and 30 (13%) for WAR. Seventy-two patients (31%) patients had no refluxsymptom association. In the group of patients on-PPI (N = 70; 36F/34M, mean age 50; 9% ERD/91% NERD), 9 (13%) had an abnormal AET. Out of 61 (87%) with normal AET, 7 (10%) had a positive SAP for AR, 24 (34%) for WAR and 4 (6%) for both AR and WAR. Twenty-six (37%) patients had no reflux-symptom association. Identifying patients with symptomatic WAR reduces the number of patients with unexplained NCCP from 102 (44%) to 72 (31%) and from 50 (71%) to 28 (37%) among patients off-PPI and on-PPI, respectively (p<0.01). CONCLUSION: Our data emphasize the important role of WAR in provoking NCCP, in particular in patients on acid-suppressive therapy. This further supports the use of MII-pH in the diagnostic algorithm of unexplained chest pain.I documenti in SFERA sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
