Accepted

British Journal of Clinical Pharmacology, 2007

Digestive diseases and sciences, 1997

Gastroesophageal reflux (GER) occurs in 22-66% of patients with noncardiac chest pain (NCCP). Although open-label investigations have shown beneficial effects of antireflux therapy in NCCP, no double-blind, prospective, placebo-controlled studies have been conducted. The purpose of this study was to evaluate the effects of omeprazole compared to placebo in a prospective, double-blind, randomized trial of patients with NCCP and GER. Thirty-six consecutive patients with NCCP and GER documented by 24-hr ambulatory pH testing entered this study. The subjects were randomized to omeprazole, 20 mg by mouth twice a day (17 patients), or placebo (19 patients) for eight weeks. Patients on omeprazole obtained significantly more improvement in the fraction of chest pain days (P = 0.006) and severity (P = 0.032) when compared to placebo. More patients in the omeprazole group reported improvement in individual daily pain scores (81% vs 44%, P = 0.03) and individual severity scores (81% vs 50%, P ...

Neurogastroenterology & Motility

Non-cardiac chest pain, defined as recurrent chest pain that is indistinguishable from ischemic anginal pain after a reasonable workup has excluded a cardiac etiology, is a prevalent disorder resulting in high healthcare utilization and significant work absenteeism. 1 An important step in identifying the underlying mechanisms behind NCCP was the recognition that gastro-esophageal reflux disease (GERD) is the most common contributing factor, affecting 40%-50% of the patients. 1 The mechanism by which gastro-esophageal reflux causes chest pain in some patients and heartburn in others remains to be elucidated. In patients with non-GERD-related symptoms, esophageal motility disorders and functional chest pain are the

Alimentary Pharmacology and Therapeutics, 2003

Background: A link between gastro-oesophageal reflux disease and coronary heart disease has been suggested. Aim: To estimate the incidence of myocardial infarction in patients with newly diagnosed gastro-oesophageal reflux disease in comparison with that in the general population. Methods: A population-based cohort study was performed in the UK. Patients aged 18-79 years with a first diagnosis of gastro-oesophageal reflux disease (n ¼ 7084) were identified and a group of 10 000 patients free of gastro-oesophageal reflux disease were sampled. A nested case-control analysis was performed to assess the risk factors for myocardial infarction. Results: The incidence of myocardial infarction in the general population was 4.0 per 1000 person-years [95% confidence interval (CI), 3.2-4.9] and 5.1 per 1000 person-years (95% CI, 4.1-6.4) in patients with gastro-oesophageal reflux disease. The relative risk of myocardial infarction in patients with gastrooesophageal reflux disease was 1.4 (95% CI, 1.0-1.9). The increased risk of myocardial infarction was limited to the immediate days after the diagnosis of gastrooesophageal reflux disease. Previous chest pain was an important predictor of myocardial infarction in patients free of gastro-oesophageal reflux disease. No association was found between the use of acid-suppressing drugs and the risk of myocardial infarction. Conclusion: Our results suggest that gastro-oesophageal reflux disease is not an independent predictor of myocardial infarction. Rather, the increased risk of myocardial infarction in patients with gastro-oesophageal reflux disease in the immediate days after diagnosis indicates that prodromal ischaemic symptoms were misinterpreted as reflux symptoms.

Cancer Epidemiology Biomarkers & Prevention

Drugs, 2004

Gastroenterology Clinics of North America, 2008

Noncardiac chest pain (NCCP) is a very common disorder of international proportions. In the United States, nearly 70 million patients (23% of the population) suffer from NCCP. 1 Population-based studies have also reported similar figures in: Australia, 33%; 2 South China, 21%; 3 Argentina, 24%; 4 and Spain, 8% to 28%. 5 Patients with NCCP represent a significant economic impact. They account for 2% to 5% of all emergency room evaluations and are one of the most frequent causes of hospital admission in the western world. 6 A United States household survey of functional gastrointestinal disorders found that NCCP patients are usually gainfully employed and lose an average of 13 days of work each year. 7 The pathophysiology of NCCP is complex and poorly understood. Several mechanisms have been identified as possible sources of pain, including gastroesophageal reflux (GER), visceral hyperalgesia, esophageal motility disorders, psychiatric dysfunction, abnormal biomechanical properties of the esophageal wall, sustained esophageal contractions, abnormal cerebral processing of visceral stimulation, and disrupted autonomic activity. 8-11 Treatment of NCCP is challenging due to the heterogeneous nature of this disorder. It is also possible that many patients suffer from more than one condition. Selection of therapy is frequently aimed at the suspected underlying process. The purpose of this article is to provide a focused review of available treatment modalities for this challenging disorder. GASTROESOPHAGEAL REFLUX GER is the most common cause of NCCP, and the best studied. 12 The benefits of acid inhibition in NCCP have been demonstrated during short-(1 day-2 weeks) and longterm (6-8 weeks) trials. Tables 1 and 2 13-24 summarize the studies that have examined the impact of acid-inhibitory therapy in NCCP. These trials underscore the favorable effect of acid suppression in NCCP. Table 1 shows that for long-term therapy, only two studies were double blind and placebo controlled; and one is available only as an abstract. Table 2 shows that for short-term therapy, five studies were placebo controlled and two studies (available only as an abstract) were not. Overall, sample size is

Disease-a-Month, 2008

Gastroenterology Clinics of North America, 2004

Alimentary Pharmacology & Therapeutics, 2004

Background: Empirical trial with high-dose omeprazole has been shown to be a sensitive tool for diagnosing patients with gastro-oesophageal reflux disease-related non-cardiac chest pain. Aim: To determine the clinical value of an empirical trial of high-dose lansoprazole in detecting patients with gastro-oesophageal reflux disease-related non-cardiac chest pain. Methods: Patients who were referred by a cardiologist after a comprehensive evaluation, with at least three episodes per week of unexplained chest pain as the predominant symptom, were enrolled into the study. Oesophageal mucosal disease was determined by upper endoscopy followed by 24-h oesophageal pH monitoring to assess acid exposure. Patients were then randomized to either placebo or lansoprazole 60 mg am and 30 mg pm for 7 days. After a washout period of 1 week, patients crossed over to the other arm of the study for an additional 7 days. Patients completed a daily diary assessing severity and frequency of chest pain as the predominant symptom throughout the baseline treatment and washout periods. The lansoprazole empirical trial was considered