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 18 November 2017

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News

Esophageal and upper gut findings in patients with non-cardiac chest pain

June's issue of The American Journal of Gastroenterology compares the prevalence of esophageal and upper gut mucosal findings in patients undergoing upper endoscopy for NCCP with those having GERD symptoms.

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Available data on the prevalence of esophageal and upper gut findings in patients with noncardiac chest pain (NCCP) are scarce.

Dr Ram Dickman and colleagues from the USA created a study to determine the prevalence of esophageal and upper gut mucosal findings in patients undergoing upper endoscopy for NCCP only, versus those with gastroesophageal reflux disease (GERD) symptoms only, using the national Clinical Outcomes Research Initiative (CORI) database.

During the study period, the CORI database received endoscopic reports from a network of 76 community, university, and Veteran Administration Health Care System (VAHCS)/military practice sites.

44.1% of patients with NCCP had a normal upper endoscopy
The American Journal of Gastroenterology

All adult patients who underwent an upper endoscopy for NCCP only or GERD-related symptoms only were identified.

Demographic characteristics and prevalence of endoscopic findings were compared between the two groups.

A total of 3,688 consecutive patients undergoing an upper endoscopy for NCCP and 32,981 for GERD were identified.

Normal upper endoscopy was noted in 44.1% of NCCP patients versus 38.8% of those with GERD (P < 0.0001).

Of the NCCP group, 28.6% had a hiatal hernia (HH), 19.4% erosive esophagitis (EE), 4.4% Barrett's esophagus (BE), and 3.6% stricture/stenosis.

However, HH, EE, and BE were significantly more common in the GERD group as compared with the NCCP group (44.8%, 27.8%, and 9.1%, respectively, P < 0.0001).

In univariate analysis of patients with NCCP, male gender was a risk factor for BE (OR 1.86, 95% CI 1.35-2.55, P = 0.0001) and being nonwhite was protective (OR 0.43, 95% CI 0.22-0.86, P = 0.02).

In this group, male gender was also a risk factor for EE (OR 1.31, 95% CI 1.11-1.54, P = 0.001) and age ≥65 yr was protective (OR 0.73, 95% CI 0.6-0.89, P = 0.002).

The NCCP group had a significantly higher prevalence of peptic ulcer in the upper gastrointestinal tract as compared with the GERD group (2.0% vs 1.5%, P = 0.01).

Dr Dickman concluded that, "In this endoscopic prevalence study, most of the endoscopic findings in NCCP were GERD related, but less common when compared with GERD patients".

The American Journal of Gastroenterology 2007; 102 (6), 1173-1179
12 June 2007

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