PMID- 14679323
OWN - NLM
STAT- MEDLINE
DCOM- 20040422
LR  - 20190817
IS  - 0192-0790 (Print)
IS  - 0192-0790 (Linking)
VI  - 38
IP  - 1
DP  - 2004 Jan
TI  - Evaluation of symptom index in identifying gastroesophageal reflux 
      disease-related noncardiac chest pain.
PG  - 24-9
AB  - BACKGROUND: Symptom index (SI), which represents the percentage of perceived 
      gastroesophageal reflux-related symptoms that correlate with esophageal acid 
      reflux events (pH <4), has been suggested as a measure to improve diagnosis of 
      gastroesophageal reflux (GER)-related noncardiac chest pain (NCCP). Because no 
      study has evaluated the value of the symptom index in NCCP patients, data to 
      support this claim have yet to be elucidated. AIM: To evaluate the value of SI in 
      identifying gastroesophageal reflux disease (GERD)-related NCCP patients. 
      METHODS: Patients enrolled in this study were referred by a cardiologist after a 
      comprehensive work-up excluded a cardiac cause for their chest pain. All patients 
      underwent upper endoscopy to determine esophageal inflammation and 24-hour 
      esophageal pH monitoring to assess esophageal acid exposure. Patients were 
      instructed to record all chest pain episodes during the pH test. Patients with a 
      positive SI (> or =50%) underwent the proton pump inhibitors (PPI) test, which is 
      a therapeutic trial using a short course of high dose PPI. RESULTS: A total of 94 
      patients with NCCP were included in this study. Forty-seven (50%) had either a 
      positive upper endoscopy or an abnormal pH test and were considered 
      GERD-Positive. Forty-seven patients (50%) had both tests negative and were 
      considered GERD-Negative. Total number of reflux episodes and percent total, 
      supine and upright time pH less than 4, were significantly higher in the 
      GERD-Positive group as compared with the GERD-Negative group (P < 0.0001, P < 
      0.0001, P = 0.0045, and P < 0.0001 respectively). Only 9 (19.1%) patients in the 
      GERD-Positive group and 5 (10.6%) patients in the GERD-Negative group had a 
      positive SI (p = ns). Eight (89%) out of the 9 patients who had a positive SI in 
      the GERD-Positive group and 2 (40%) out of 5 patients in the GERD-Negative group 
      responded to the PPI test. CONCLUSION: Positive SI is relatively uncommon in NCCP 
      patients, regardless if GERD is present or absent. Hence, symptom index provides 
      very little improvement in diagnosing GERD-related NCCP.
FAU - Dekel, Roy
AU  - Dekel R
AD  - Section of Gastroenterology, Department of Medicine, Southern Arizona VA Health 
      Care System and University of Arizona Health Science Center, 3601 S. 6th Avenue, 
      Tucson, AZ 85723, USA.
FAU - Martinez-Hawthorne, Stephanie D
AU  - Martinez-Hawthorne SD
FAU - Guillen, R Jose
AU  - Guillen RJ
FAU - Fass, Ronnie
AU  - Fass R
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Clin Gastroenterol
JT  - Journal of clinical gastroenterology
JID - 7910017
SB  - IM
CIN - J Clin Gastroenterol. 2004 Jan;38(1):5-6. PMID: 14679319
MH  - Acid-Base Equilibrium
MH  - Chest Pain/*diagnosis/etiology
MH  - Endoscopes, Gastrointestinal
MH  - Female
MH  - Gastroesophageal Reflux/complications/*pathology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Monitoring, Ambulatory/methods
MH  - Sensitivity and Specificity
MH  - Severity of Illness Index
EDAT- 2003/12/18 05:00
MHDA- 2004/04/23 05:00
CRDT- 2003/12/18 05:00
PHST- 2003/12/18 05:00 [pubmed]
PHST- 2004/04/23 05:00 [medline]
PHST- 2003/12/18 05:00 [entrez]
AID - 10.1097/00004836-200401000-00007 [doi]
PST - ppublish
SO  - J Clin Gastroenterol. 2004 Jan;38(1):24-9. doi: 10.1097/00004836-200401000-00007.