By Ronnie Fass
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Extra resources for Noncardiac Chest Pain: An Issue of Gastroenterology Clinics of North America Vol 33 Issue 1
12] Dekel R, Martinez-Hawthorne SD, Guillen RJ, Fass R. Evaluation of symptom index (SI) in identifying gastroesophageal reﬂux disease (GERD)-related noncardiac chest pain (NCCP). J Clin Gastroenterol, in press.  Richter JE. Extraesophageal presentations of gastroesophageal reﬂux disease: an overview. Am J Gastroenterol 2000;95(Suppl):S1–3.  Wong WM, Lai KC, Lau C, Hu WH, Chen WH, Wong BC, et al. Upper gastrointestinal evaluation of Chinese patients with non-cardiac chest pain. Aliment Pharmacol Ther 2002; 16:465–71.
Pain resolved in the 12 patients when treated surgically (eight patients) or by acid reducing agents. Patti et al  reviewed patients who underwent laparoscopic fundoplication for GERD who complained of chest pain in addition to heartburn and acid regurgitation. Overall, chest pain improved in 85% of the patients after laparoscopic fundoplication. This increased to 96% in patients whose chest pain correlated with GERD most of the time. Farrell et al  evaluated the eﬀectiveness of anti-reﬂux surgery for patients with atypical manifestations of GERD.
If symptoms occur less than once per week, the test may be extended to 2 weeks or longer. When using the PPI test, there was a signiﬁcant correlation between the esophageal acid exposure by 24-hour esophageal pH monitoring and the change in symptom intensity score after treatment . This suggests that the higher the esophageal acid exposure, the greater the response to the PPI test in patients with GERD-related NCCP. M. Faybush, R. Fass / Gastroenterol Clin N Am 33 (2004) 41–54 49 Studies have also demonstrated that using the PPI test as the ﬁrst diagnostic tool in patients with NCCP is cost eﬀective.