Comparison of one-week and two-week empirical trial with a high-dose rabeprazole in non-cardiac chest pain patients.
BACKGROUND
In patients with non-cardiac chest pain (NCCP), the optimal duration of an empirical trial with a high-dose proton pump inhibitor (PPI) is unclear. We aimed to compare the efficacy of one-week and two-week PPI trial in patients with weekly or more than weekly NCCP and to determine its optimal duration for diagnosing gastroesophageal reflux disease (GERD)-related NCCP.


METHODS
Forty-two patients with at least weekly NCCP were enrolled. The baseline symptoms were assessed using a daily symptom diary for seven days. Also, esophago-gastro-duodenoscopy and 24 h esophageal pH monitoring were performed for the diagnosis of GERD. Then, patients were treated with rabeprazole 20 mg twice daily for 14 days. To assess NCCP improvement during the PPI trial, the first week and the second week symptom diary were kept for 1-7 and 8-14 days. The PPI test was considered positive if a symptom score improved (50% compared to the baseline.


RESULTS
There was no significant difference for a positive PPI test between GERD-related NCCP group (n = 8, 50%) and non GERD-related NCCP group (n = 6, 23%) during the first week of the PPI test. However, during the second week, GERD-related NCCP had a higher positive PPI test (n = 13, 81%) than non GERD-related NCCP (n = 7, 27%) (P = 0.001) with a sensitivity and specificity of 81% and 62%, respectively.


CONCLUSIONS
The rabeprazole empirical trial was diagnostic for patients with GERD-related NCCP, and its optimal duration was determined to be at least two weeks.
Kim
Jeong Hwan
JH
Department of Internal Medicine, Konkuk University School of Medicine, School of Medicine, Seoul, Korea.
Sinn
Dong Hyun
DH
Son
Hee Jung
HJ
Kim
Jae J
JJ
Rhee
Jong Chul
JC
Rhee
Poong-Lyul
PL
D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D002637:Chest Pain / Q000188:drug therapy* / Q000209:etiology; D004334:Drug Administration Schedule; D036262:Empirical Research; D016145:Endoscopy, Digestive System; D050782:Esophageal pH Monitoring; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D054328:Proton Pump Inhibitors / Q000008:administration & dosage*; D064750:Rabeprazole; D012107:Research Design; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D054328:Proton Pump Inhibitors; D064750:Rabeprazole