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 24 January 2018

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News

Omeprazole as a first diagnostic approach to noncardiac chest pain

Researchers from Virginia, USA, have found that omeprazole is a superior first diagnostic tool, to other methods, in determining the cause of noncardiac chest pain.

News image

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Noncardiac chest pain (NCCP) presents as a frequent diagnostic challenge, with patients tending to use a disproportionate level of health care resources.

Gastroesophageal reflux disease (GERD) is the most frequent cause of NCCP.

The research team, from the Virginia Commonwealth University, tested the efficacy of a potent acid-suppressing agent as a diagnostic test in the evaluation of NCCP. They then compared it with 3 commonly used tests.

The findings of the study are published in the latest issue of the Journal of Clinical Gastroenterology.

There were 42 patients in the study, 18 men and 24 women aged between 22 and 77 years.

All presented with recurrent chest pain complaints of a noncardiac etiology, as determined by rest/stress perfusion imaging with technetium Tc99m sestamibi (MIBI).

Patients were randomly assigned to either the placebo or omeprazole (40 mg/d orally twice daily) for 14 days. They were then washed out for 21 days and were crossed over.

95% of patients with GERD respond to omeprazole.
Journal of Clinical Gastroenterology

Of the 42 patients, 37 completed both arms of the trial.

In addition, all patients underwent initial diagnostic upper endoscopy, esophageal manometry, and 24-hour pH monitoring.

Each patient's symptoms were determined using a visual analogue scale to measure the severity of chest pain before and after each period.

The team found that 71% of patients receiving omeprazole reported improved chest pain, compared to 18% receiving the placebo.

Furthermore, abnormal results on manometry (20%), 24-hour pH monitoring (42%), or endoscopy with visual evidence of esophagitis (26%) were found less frequently.

In NCCP patients with GERD, omeprazole treatment led to a response in 95% of patients.

On the other hand, 90% of GERD-positive patients treated with placebo did not respond.

Of NCCP patients determined to be GERD-negative, 39% responded to omeprazole.

Dr William Pandak's research team concluded, "Omeprazole as a first diagnostic tool in the evaluation of MIBI-negative NCCP is sensitive and specific for determining the cause of NCCP".

He added that, "Endoscopy, manometry, and 24-hour pH monitoring were not only less sensitive in diagnosing NCCP, but they were significantly more expensive".

J Clin Gastroenterol 2002; 35 (4): 307-14
26 September 2002

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