title: [What is the utility of proton pump inhibitor testing in non-cardiac chest pain?].
abstract: OBJECTIVE
  Noncardiac chest pain (NCCP) often represents a diagnostic and therapeutic challenge. Given that gastroesophageal reflux disease (GERD) is the most common cause of NCCP, initial treatment with proton-pump inhibitors (PPI) has been proposed for all patients (PPI testing), reserving esophageal function testing solely for non-responders. The aim of the present study was to provide evidence on the clinical utility of PPI testing with high-dose pantoprazole in patients with NCCP.
  
  
  METHODS
  We carried out a study of diagnostic performance with a cohort design in patients with NCCP, who had been assessed by the Cardiology Service. All patients underwent upper endoscopy, esophageal manometry, and 24h esophageal pH monitoring before PPI testing with pantoprazole 40 mg every 12h for 1 month. Before and after treatment, we assessed the severity (intensity and frequency) of chest pain, quality of life, and anxiety and depression by means of specific questionnaires. The diagnosis of GERD was based on a pathological finding of esophageal pH monitoring. A positive response to PPI testing was defined as an improvement in chest pain >50% compared with the baseline score after 1 month of PPI therapy.
  
  
  RESULTS
  We included 30 consecutive patients (17 men/13 women) with a mean age of 49 years. Of these 30 patients, 20 with NCCP had GERD (67%, 95%CI: 47%-83%). A positive response to PPI therapy was observed in 13 of the 30 (43%) patients with NCCP: 11 of the 20 (55%) patients in the GERD-positive group and 2 of the 10 (20%) in the GERD-negative group. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of PPI testing was 55%, 80%, 85%, 47% and 63%, respectively. A significant reduction in chest pain after pantoprazole therapy (P=.003) and a slight non significant improvement in anxiety and depression was achieved in the GERD-positive group as compared to the GERD-negative group.
  
  
  CONCLUSIONS
  In NCCP, PPI testing with pantoprazole has a low sensitivity for the diagnosis of GERD, placing in doubt the strategy of reserving functional study to non-responders to antisecretory therapy. Esophageal function testing and accurate diagnosis would allow appropriate targeted therapy for all patients with NCCP.
authors.affiliation: Servicio de Aparato Digestivo y Endoscopia, Hospital General de Catalunya, UIC, Sant Cugat del Vallès, Barcelona, España.
authors.forename: José Wálter
authors.initials: JW
authors.lastname: Huamán
authors.affiliation: Servicio de Cardiología, Hospital General de Catalunya, Sant Cugat del Vallès, Barcelona, España.
authors.forename: Verónica
authors.initials: V
authors.lastname: Aliaga
authors.affiliation: Servicio de Aparato Digestivo y Endoscopia, Hospital General de Catalunya, UIC, Sant Cugat del Vallès, Barcelona, España.
authors.forename: Gemma
authors.initials: G
authors.lastname: Domenech
authors.affiliation: Departamento de Ciencias Experimentales y de la Salud, Facultad de Ciencias de la Salud y de la Vida, Universitat Pompeu Fabra, Barcelona, España.
authors.forename: Sebastián
authors.initials: S
authors.lastname: Videla
authors.affiliation: Servicio de Aparato Digestivo y Endoscopia, Hospital General de Catalunya, UIC, Sant Cugat del Vallès, Barcelona, España. Electronic address: esapfra@gmail.com.
authors.forename: Esteban
authors.initials: E
authors.lastname: Saperas
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000627:therapeutic use; D002637:Chest Pain / Q000209:etiology*; D015331:Cohort Studies; D003937:Diagnosis, Differential; D050782:Esophageal pH Monitoring; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D006331:Heart Diseases / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077402:Pantoprazole; D054328:Proton Pump Inhibitors / Q000627:therapeutic use
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D054328:Proton Pump Inhibitors; D000077402:Pantoprazole
keywords: Dolor torácico no cardíaco; Enfermedad por reflujo gastroesofágico; Gastroesophageal reflux disease; Noncardiac chest pain; Test de inhibidores de la bomba de protones; Testing proton-pump inhibitors