TY - JOUR
T1 - Determinants of the Association between Non-Cardiac Chest Pain and Reflux
AU - Herregods, Thomas V K
AU - Bredenoord, Albert J
AU - Oors, Jacobus M
AU - Bogte, Auke
AU - Smout, André J P M
N1 - Funding Information:
Guarantor of the article: Thomas V.K. Herregods, MD. Specific author contributions: T.H. designed the study, collected data, analyzed, and interpreted data, drafted the manuscript, and critically revised the article for important intellectual content; J.O. and A.B. collected data and critically revised the article for important intellectual content; A.J.B. and A.S. designed the study, interpreted data, and critically revised the manuscript for important intellectual content. Financial support: T.V.K. Herregods is funded by the European Union’s Seventh Framework Programme under REA grant agreement no. 607652 (NeuroGut). Potential competing interests: A.J.B. received research funding from Endostim, Medical Measurement Systems, Danone, and Given and received speaker and/or consulting fees from MMS, Astellas, AstraZeneca, and Almirall. The remaining authors declare no conflict of interest.
PY - 2017/11
Y1 - 2017/11
N2 - OBJECTIVES: Gastroesophageal reflux is considered to be the most common gastrointestinal cause of non-cardiac chest pain (NCCP). It remains unclear why some reflux episodes in the same patient cause chest pain while others do not. To understand more about the mechanisms by which reflux elicits chest pain, we aimed to identify factors which are important in triggering chest pain.METHODS: In this multicenter study, 120 patients with NCCP were analyzed using 24-h pH-impedance monitoring. In the patients with a positive association between reflux and chest pain, the characteristics of the reflux episodes which were followed by a chest pain episode were compared with chest pain-free reflux episodes.RESULTS: Using 24-h pH-impedance monitoring, 40% of the NCCP patients were identified as having reflux as a possible cause of their chest pain. Reflux episodes that were associated with chest pain had a higher proximal extent (P=0.007), a higher volume clearance time (P=0.030), a higher 15-minute acid burden (P=0.041), were more often acidic (P=0.011), had a lower nadir pH (P=0.044), and had a longer acid duration time (P=0.027) than reflux episodes which were not followed by chest pain. Patients who experienced typical reflux symptoms were more likely to have reflux as the cause of their chest pain (52 vs. 31.4%, P=0.023).CONCLUSIONS: The presence of a larger volume of acid refluxate for a longer period of time appears to be an important determinant of perceiving a reflux episode as chest pain. 24-h pH-impedance monitoring is an important tool in identifying gastroesophageal reflux as a potential cause of symptoms in patients with NCCP.
AB - OBJECTIVES: Gastroesophageal reflux is considered to be the most common gastrointestinal cause of non-cardiac chest pain (NCCP). It remains unclear why some reflux episodes in the same patient cause chest pain while others do not. To understand more about the mechanisms by which reflux elicits chest pain, we aimed to identify factors which are important in triggering chest pain.METHODS: In this multicenter study, 120 patients with NCCP were analyzed using 24-h pH-impedance monitoring. In the patients with a positive association between reflux and chest pain, the characteristics of the reflux episodes which were followed by a chest pain episode were compared with chest pain-free reflux episodes.RESULTS: Using 24-h pH-impedance monitoring, 40% of the NCCP patients were identified as having reflux as a possible cause of their chest pain. Reflux episodes that were associated with chest pain had a higher proximal extent (P=0.007), a higher volume clearance time (P=0.030), a higher 15-minute acid burden (P=0.041), were more often acidic (P=0.011), had a lower nadir pH (P=0.044), and had a longer acid duration time (P=0.027) than reflux episodes which were not followed by chest pain. Patients who experienced typical reflux symptoms were more likely to have reflux as the cause of their chest pain (52 vs. 31.4%, P=0.023).CONCLUSIONS: The presence of a larger volume of acid refluxate for a longer period of time appears to be an important determinant of perceiving a reflux episode as chest pain. 24-h pH-impedance monitoring is an important tool in identifying gastroesophageal reflux as a potential cause of symptoms in patients with NCCP.
KW - Chest Pain/etiology
KW - Deglutition Disorders/etiology
KW - Electric Impedance
KW - Esophageal pH Monitoring
KW - Female
KW - Gastroesophageal Reflux/complications
KW - Heartburn/etiology
KW - Humans
KW - Hydrogen-Ion Concentration
KW - Male
KW - Middle Aged
KW - Time Factors
UR - https://www.scopus.com/pages/publications/85032980445
U2 - 10.1038/ajg.2017.288
DO - 10.1038/ajg.2017.288
M3 - Article
C2 - 29016562
SN - 0002-9270
VL - 112
SP - 1671
EP - 1677
JO - American Journal of Gastroenterology
JF - American Journal of Gastroenterology
IS - 11
ER -