Origin of and therapeutic approach to cardiac syndrome X: results of the proton pump inhibitor therapy for angina-like lingering pain trial (PITFALL trial).
OBJECTIVE
To investigate the frequency of gastroenterological diseases in the etiology and the efficacy of proton pump inhibitors (PPIs) in the treatment of cardiac syndrome X (CSX) as a subform of non-cardiac chest pain (NCCP).


METHODS
We investigated 114 patients with CSX using symptom questionnaires. A subgroup of these patients were investigated regarding upper gastrointestinal disorders (GIs) and treated with PPI. Patients not willing to participate in investigation and treatment served as control group.


RESULTS
Thirty-six patients denied any residual symptoms and were not further evaluated. After informed consent in 27 of the remaining 78 patients, we determined the prevalence of disorders of the upper GI tract and quantified the effect of treatment with pantoprazole. We found a high prevalence of gastroenterological pathologies (26/27 patients, 97%) with gastritis, gastroesophageal reflux disease (GERD) and acid reflux as the most common associated disorders. If treated according to the study protocol, these patients showed a significant improvement in the symptom score. Patients treated by primary care physicians, not according to the study protocol had a minor response to treatment (n = 19, -43%), while patients not treated at all (n = 26) had no improvement of symptoms (-0%).


CONCLUSIONS
Disorders of the upper GI tract are a frequent origin of CSX in a German population and can be treated with pantoprazole if given for a longer period.
Dietrich
Christoph-G
CG
Division of Gastroenterology and Hepatology, University Hospital Zurich, Ramistr. 100, Zurich 8091, Switzerland.
Laupichler
Susanne
S
Stanzel
Sven
S
Winograd
Ron
R
Al-Taie
Oliver
O
Gartung
Carsten
C
Geier
Andreas
A
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000368:Aged; D002637:Chest Pain / Q000188:drug therapy* / Q000209:etiology; D017023:Coronary Angiography; D004311:Double-Blind Method; D005260:Female; D005756:Gastritis / Q000150:complications / Q000188:drug therapy; D005764:Gastroesophageal Reflux / Q000150:complications / Q000188:drug therapy; D005767:Gastrointestinal Diseases / Q000150:complications / Q000188:drug therapy*; D005858:Germany; D006801:Humans; D008297:Male; D017566:Microvascular Angina / Q000188:drug therapy* / Q000209:etiology; D008875:Middle Aged; D000077402:Pantoprazole; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D054328:Proton Pump Inhibitors; D000077402:Pantoprazole