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Extra resources for Noncardiac Chest Pain: An Issue of Gastroenterology Clinics of North America Vol 33 Issue 1

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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. [13] Richter JE. Extraesophageal presentations of gastroesophageal reflux disease: an overview. Am J Gastroenterol 2000;95(Suppl):S1–3. [14] 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 [46] 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 [47] 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 [37]. 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.

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