title: Heartburn or angina? Differentiating gastrointestinal disease in primary care patients presenting with chest pain: a cross sectional diagnostic study.
abstract: BACKGROUND
  Gastrointestinal (GI) disease is one of the leading aetiologies of chest pain in a primary care setting. The aims of the study are to describe clinical characteristics of GI disease causing chest pain and to provide criteria for clinical diagnosis.
  
  
  METHODS
  We included 1212 consecutive patients with chest pain aged 35 years and older attending 74 general practitioners (GPs). GPs recorded symptoms and findings of each patient and provided follow up information. An independent interdisciplinary reference panel reviewed clinical data of each patient and decided about the aetiology of chest pain. Multivariable regression analysis was performed to identify clinical predictors that help to rule in or out the diagnosis of GI disease and Gastroesophageal Reflux Disease (GERD).
  
  
  RESULTS
  GI disease was diagnosed in 5.8% and GERD in 3.5% of all patients. Most patients localised the pain retrosternal (71.8% for GI disease and 83.3% for GERD). Pain worse with food intake and retrosternal pain radiation were associated positively with both GI disease and GERD; retrosternal pain localisation, vomiting, burning pain, epigastric pain and an average pain episode < 1 hour were associated positively only with GI disease. Negative associations were found for localized muscle tension (GI disease and GERD) and pain getting worse on exercise, breathing, movement and pain location on left side (only GI disease).
  
  
  CONCLUSIONS
  This study broadens the knowledge about the diagnostic accuracy of selected signs and symptoms for GI disease and GERD and provides criteria for primary care practitioners in rational diagnosis.
authors.affiliation: Department of General Practice/Family Medicine, University of Marburg, 35032 Marburg, Germany. boesner@staff.uni-marburg.de.
authors.forename: Stefan
authors.initials: S
authors.lastname: Bösner
authors.forename: Jörg
authors.initials: J
authors.lastname: Haasenritter
authors.forename: Annette
authors.initials: A
authors.lastname: Becker
authors.forename: Maren A
authors.initials: MA
authors.lastname: Hani
authors.forename: Heidi
authors.initials: H
authors.lastname: Keller
authors.forename: Andreas C
authors.initials: AC
authors.lastname: Sönnichsen
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Karatolios
authors.forename: Juergen R
authors.initials: JR
authors.lastname: Schaefer
authors.forename: Erika
authors.initials: E
authors.lastname: Baum
authors.forename: Norbert
authors.initials: N
authors.lastname: Donner-Banzhoff