Is proton pump inhibitor testing an effective approach to diagnose gastroesophageal reflux disease in patients with noncardiac chest pain?: a meta-analysis.
BACKGROUND
Gastroesophageal reflux disease (GERD) is common in patients with noncardiac chest pain (NCCP). Results of studies evaluating the accuracy of a proton pump inhibitor (PPI) treatment as a diagnostic test for GERD-related NCCP have varied. We evaluated the overall accuracy of this modality.


METHODS
We searched the PubMed, MEDLINE, EMBASE, CINAHL, and Cochrane databases to May 2004 and included randomized, placebo-controlled studies evaluating the accuracy of findings from PPI testing in the diagnosis of GERD in patients with NCCP. The GERD diagnosis was confirmed by results of endoscopy and/or 24-hour esophageal pH monitoring. A summary diagnostic odds ratio and summary receiver operating characteristic curve analysis were used to estimate the overall accuracy and to explore any contributing factors.


RESULTS
Six studies met the inclusion criteria. The overall sensitivity and specificity of a PPI test were 80% (95% confidence interval [CI], 71%-87%) and 74% (95% CI, 64%-83%), respectively, compared with 19% (95% CI, 12%-29%) and 77% (95% CI, 62%-87%), respectively, in the placebo group. The PPI test showed a significant higher discriminative power, with a summary diagnostic odds ratio of 19.35 (95% CI, 8.54-43.84) compared with 0.61 (95% CI, 0.20-1.86) in the placebo group. The impact of the prevalence of GERD and treatment duration on the accuracy of the test could not be determined because of the lack of an adequate number of studies.


CONCLUSIONS
The use of PPI treatment as a diagnostic test for detecting GERD in patients with NCCP has an acceptable sensitivity and specificity and could be used as an initial approach by primary care physicians to detect GERD in selected patients with NCCP.
Wang
Wei Hong
WH
Department of Gastroenterology, Peking University First Hospital, Beijing, China.
Huang
Jia Qing
JQ
Zheng
Ge Fan
GF
Wong
Wai Man
WM
Lam
Shiu Kum
SK
Karlberg
Johan
J
Xia
Harry H X
HH
Fass
Ronnie
R
Wong
Benjamin C Y
BC
D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D002637:Chest Pain / Q000209:etiology*; D003938:Diagnostic Techniques, Digestive System; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D054328:Proton Pump Inhibitors; D012680:Sensitivity and Specificity
D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors