title: Clinically distinct characteristics in patients younger than 40 years old with non-cardiac chest pain.
abstract: OBJECTIVE
  Little is known about non-cardiac chest pain (NCCP) in young patients. We aimed to examine the proportion of gastroesophageal reflux disease (GERD) in young patients with NCCP compared to the average-aged NCCP patients and to evaluate their symptomatic characteristics and the clinical efficacy of a 2-week proton pump inhibitor (PPI) trial.
  
  
  METHODS
  Ninety-six patients with NCCP≥1/week were classified into the young-aged (≤ 40 years, n =38) and the average-aged groups (>40 years, n=58). Typical reflux symptoms were assessed. The patients were defined into a GERD group and non-GERD group according to reflux esophagitis on esophagogastroduodenoscopy and/or pathologic acid exposure on 24-h esophageal pH monitoring. Then the patients were treated with 30mg of lansoprazole bid for 14 days.
  
  
  RESULTS
  Nine patients (23%) in the young-aged group and 22 patients (38%) in average-aged group were diagnosed with GERD-related NCCP (P=0.144). The proportion of typical reflux symptoms was higher in the GERD group compared with the non-GERD group in both age groups. A PPI test improved symptoms in the GERD group irrespective of age, but this improvement was not observed in non-GERD group.
  
  
  CONCLUSIONS
  In young NCCP patients, the prevalence of GERD was relatively low compared to average-aged NCCP, but the difference was insignificant. The PPI test was very effective in diagnosing GERD in the NCCP patients in both age groups. Therefore, in young NCCP patients, if there is a negative response to a 2-week PPI trial, the possibility of extra-esophageal disease origin needs to be considered.
authors.affiliation: Department of Internal Medicine, Digestive Disease Center, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Korea.
authors.forename: Soon Young
authors.initials: SY
authors.lastname: Ko
authors.forename: So-I
authors.initials: SI
authors.lastname: Kim
authors.forename: Jeong Hwan
authors.initials: JH
authors.lastname: Kim
authors.forename: Jung Hyeon
authors.initials: JH
authors.lastname: Lee
authors.forename: Kyung-Ju
authors.initials: KJ
authors.lastname: Lee
authors.forename: Sung Noh
authors.initials: SN
authors.lastname: Hong
authors.forename: Sun-Young
authors.initials: SY
authors.lastname: Lee
authors.forename: In-Kyung
authors.initials: IK
authors.lastname: Sung
authors.forename: Hyung Seok
authors.initials: HS
authors.lastname: Park
authors.forename: Chan Sup
authors.initials: CS
authors.lastname: Shim
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000627:therapeutic use; D000328:Adult; D000367:Age Factors; D002637:Chest Pain / Q000209:etiology*; D016009:Chi-Square Distribution; D016099:Endoscopy, Gastrointestinal; D015154:Esophageal Motility Disorders / Q000150:complications; D050782:Esophageal pH Monitoring; D004942:Esophagitis, Peptic / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D004947:Esophagus / Q000503:physiopathology; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D064747:Lansoprazole; D008297:Male; D008365:Manometry; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000627:therapeutic use
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D054328:Proton Pump Inhibitors; D064747:Lansoprazole