Diagnostic and therapeutic use of proton pump inhibitors in non-cardiac chest pain: a metaanalysis.
OBJECTIVE
To assess (i) the efficacy of short-term proton pump inhibitors (PPIs) in non-cardiac chest pain (NCCP) and (ii) the performance of an empirical short-term treatment with PPI (PPI test) to establish a diagnosis of abnormal acid reflux in NCCP.


METHODS
Metaanalysis of English language studies identified by searching MEDLINE (1966-May 2004), EMBASE (1980-May 2004), Cochrane Controlled Trials Register, and abstract books from major gastroenterology meetings (1993-2004). For the metaanalysis of PPI efficacy in NCCP, we selected randomized controlled trials (parallel group and crossover designs) comparing PPI therapy with placebo. For the metaanalysis of PPI test performance, we selected uncontrolled studies comparing the test with a standard reference.


RESULTS
Eight studies were included in the PPI efficacy analysis. The pooled risk ratio for continued chest pain after PPI therapy was 0.54 (95% CI 0.41-0.71). The overall number needed to treat was 3 (95% CI 2-4). The pooled sensitivity, specificity, and diagnostic odds ratio for the PPI test versus 24-h pH monitoring and endoscopy were 80%, 74%, and 13.83 (95% CI 5.48-34.91), respectively. All studies were small and there was evidence of publication bias or other small study effects.


CONCLUSIONS
PPI therapy reduces symptoms in NCCP and may be useful as a diagnostic test in identifying abnormal esophageal acid reflux.
Cremonini
Filippo
F
Clinical Enteric Neuroscience, Translational and Epidemiological Research Program (C.E.N.T.E.R.) and Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
Wise
James
J
Moayyedi
Paul
P
Talley
Nicholas J
NJ
D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D002637:Chest Pain / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D003937:Diagnosis, Differential; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D016017:Odds Ratio; D054328:Proton Pump Inhibitors; D012372:ROC Curve; D016032:Randomized Controlled Trials as Topic / Q000379:methods* / Q000592:standards; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors