title: Bravo 48-hour Wireless pH Monitoring in Patients With Non-cardiac Chest Pain. Objective Gastroesophageal Reflux Disease Parameters Predict the Responses to Proton Pump Inhibitors.
abstract: OBJECTIVE
  In patients with non-cardiac chest pain (NCCP), gastroesophageal reflux disease (GERD) is the commonest cause and ambulatory pH is of great value in identifying these patients. However, parameters in the context of predicting therapeutic response are still unknown. By extending the monitoring period, we could better evaluate the best evidence for GERD association. Our aims were (1) to compare the outcomes of 48-hour pH monitoring to 24-hour and (2) to determine whether objective parameters could predict the treatment success in patients with NCCP using Bravo pH system.
  
  
  METHODS
  Pathological esophageal acid reflux (PEAR) and positive symptom index (SI) were calculated after 24-hour and compared to the 48-hour study. Evidence suggestive of GERD diagnosis was considered if PEAR and/or SI (+) were present on each different day. After pH study, all patients received proton pump inhibitor twice a day for 4 weeks. Treatment success was determined at the end of therapy.
  
  
  RESULTS
  Thirty-two patients with NCCP participated. GERD was identified in 20 (62.5%) patients; 17 (53.1%) had PEAR, 3 (9.4%) SI (+) and 7 (22%) both. Twelve (41%) patients exhibited PEAR values on day 1, while 17 after 2 days; a 12.1% gain. SI (+) was found in 6 patients (18.8%) on day 1 and in 4 more on day 2, a gain of 12.5%. Significantly higher proportion of patients with GERD indicators showed improvement compared to those without (90% vs 16.7%, P < 0.005).
  
  
  CONCLUSIONS
  In patients with NCCP, 48-hour pH measurement identified GERD as the cause of NCCP with an increased yield by almost 12% compared to 12 hours. Objective GERD parameters could predict response to antireflux therapy.
authors.affiliation: Hepatogastroenterology Unit, 2nd Department of Internal Medicine - Propaedeutic, Attikon University General Hospital, Athens Medical School, Athens, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Karamanolis
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Triantafyllou
authors.forename: Panagiota
authors.initials: P
authors.lastname: Psatha
authors.forename: Ioannis
authors.initials: I
authors.lastname: Vlachogiannakos
authors.forename: Asimina
authors.initials: A
authors.lastname: Gaglia
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Polymeros
authors.forename: Smaragdi
authors.initials: S
authors.lastname: Fessatou
authors.forename: Maria
authors.initials: M
authors.lastname: Triantafyllou
authors.forename: Ioannis S
authors.initials: IS
authors.lastname: Papanikolaou
authors.forename: Spiros D
authors.initials: SD
authors.lastname: Ladas