PMID- 21508423
OWN - NLM
STAT- MEDLINE
DCOM- 20120118
LR  - 20131121
IS  - 1468-3288 (Electronic)
IS  - 0017-5749 (Linking)
VI  - 60
IP  - 11
DP  - 2011 Nov
TI  - Response of unexplained chest pain to proton pump inhibitor treatment in patients 
      with and without objective evidence of gastro-oesophageal reflux disease.
PG  - 1473-8
LID - 10.1136/gut.2011.241307 [doi]
AB  - INTRODUCTION: Unexplained chest pain is potentially attributable to 
      gastro-oesophageal reflux disease (GORD) or oesophageal motility disorders. 
      Reflux chest pain may occur without heartburn. We explored the response of 
      unexplained chest pain to proton pump inhibitor (PPI) therapy in randomised 
      clinical trials (RCTs), differentiating patients with and without objective 
      evidence of GORD. METHODS: PubMed and Embase were systematically searched for 
      RCTs that reported chest pain response to PPIs in patients who had had 
      pH-monitoring and/or endoscopy to differentiate GORD-positive from GORD-negative 
      subpopulations. Heterogeneity among studies was assessed using the Cochran Q and 
      I(2) statistics, and a fixed effect model was applied. Possible publication bias 
      was assessed by Egger's test. RESULTS: Six RCTs met the inclusion criteria. All 
      used 24 h pH monitoring and/or endoscopy to define GORD-positive patients and 
      improvement in chest pain to define response (five used >/=50%; one used >/= 20%). 
      The therapeutic gain of >50% improvement with PPIs relative to placebo was 56-85% 
      in GORD-positive and 0-17% in GORD-negative patients. The RR of >50% improvement 
      in chest pain with PPI versus placebo was 4.3 (95% CI 2.8 to 6.7; p<0.0001) for 
      GORD-positive and 0.4 (95% CI 0.3 to 0.7; p=0.0004) for GORD-negative patients. 
      Concomitant heartburn varied among trials from being an exclusion criterion to 
      being essentially concordant with GORD-positive status. CONCLUSIONS: Unexplained 
      chest pain in patients with endoscopic or pH-monitoring evidence of GORD tends to 
      improve, but not resolve, with PPI therapy, whereas GORD-negative patients have 
      little or no response. Heartburn was a poor predictor of whether patients with 
      chest pain were GORD-positive or GORD-negative by objective testing.
FAU - Kahrilas, Peter J
AU  - Kahrilas PJ
AD  - Northwestern University, Feinberg School of Medicine, Chicago, IL 60611-2951, 
      USA. p-kahrilas@northwestern.edu
FAU - Hughes, Nesta
AU  - Hughes N
FAU - Howden, Colin W
AU  - Howden CW
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Review
DEP - 20110420
PL  - England
TA  - Gut
JT  - Gut
JID - 2985108R
RN  - 0 (2-Pyridinylmethylsulfinylbenzimidazoles)
RN  - 0 (Proton Pump Inhibitors)
RN  - 0K5C5T2QPG (Lansoprazole)
RN  - 32828355LL (Rabeprazole)
RN  - KG60484QX9 (Omeprazole)
SB  - IM
MH  - 2-Pyridinylmethylsulfinylbenzimidazoles/administration & dosage/therapeutic use
MH  - Chest Pain/*drug therapy/*etiology
MH  - Esophagus/physiopathology
MH  - Gastroesophageal Reflux/*complications/*drug therapy/physiopathology
MH  - Heartburn/complications
MH  - Humans
MH  - Lansoprazole
MH  - Omeprazole/administration & dosage/therapeutic use
MH  - Pain Measurement
MH  - Proton Pump Inhibitors/administration & dosage/*therapeutic use
MH  - Rabeprazole
MH  - Randomized Controlled Trials as Topic
MH  - Treatment Outcome
EDAT- 2011/04/22 06:00
MHDA- 2012/01/19 06:00
CRDT- 2011/04/22 06:00
PHST- 2011/04/22 06:00 [entrez]
PHST- 2011/04/22 06:00 [pubmed]
PHST- 2012/01/19 06:00 [medline]
AID - gut.2011.241307 [pii]
AID - 10.1136/gut.2011.241307 [doi]
PST - ppublish
SO  - Gut. 2011 Nov;60(11):1473-8. doi: 10.1136/gut.2011.241307. Epub 2011 Apr 20.