Esophageal chest pain resembles heartburn in reflux metrics and response to proton pump inhibitor therapy.
GERD
HRM
heartburn
impedance‐pH
noncardiac chest pain
regurgitation
Journal
Neurogastroenterology and motility
ISSN: 1365-2982
Titre abrégé: Neurogastroenterol Motil
Pays: England
ID NLM: 9432572
Informations de publication
Date de publication:
01 Nov 2024
01 Nov 2024
Historique:
revised:
14
10
2024
received:
24
06
2024
accepted:
19
10
2024
medline:
1
11
2024
pubmed:
1
11
2024
entrez:
1
11
2024
Statut:
aheadofprint
Résumé
Gastro-esophageal reflux disease (GERD) is the most common cause for noncardiac chest pain (NCCP), with an estimated prevalence rate ranging between 30% and 60%. Heartburn and NCCP may share common mechanisms. To assess whether particular patterns of impedance-pH variables characterize patients with dominant heartburn, regurgitation, or NCCP and their ability to predict proton pump inhibitor (PPI) response for each symptom, GERD patients, evaluated with high-resolution manometry (HRM) and impedance-pH, were included. In total, 109 NCCP, 68 heartburn, and 64 regurgitation patients were included. Pathological reflux episodes were observed in 28%, 19%, and 56% (p < 0.001). Pathological mean nocturnal baseline impedance (MNBI) values were observed in 55%, 53%, and 34% (p < 0.05). Hypomotility was more frequent in NCCP compared to heartburn patients (p < 0.05). When comparing NCCP with heartburn, hypomotility was associated with NCCP perception (OR: 2.34, 95% CI: 1.23-4.43; p < 0.01). When comparing NCCP with regurgitation, >80 refluxes and type 2/3 esophagogastric junction (EGJ) were associated with regurgitation perception (OR: 0.31, 95% CI: 0.16-0.59; p < 0.001, and OR: 0.5, 95% CI: 0.27-0.93; p < 0.05), while pathological MNBI was associated with NCCP perception (OR: 2.34, 95% CI: 1.23-4.43; p < 0.01). 45.5% NCCP patients, 45.6% with heartburn, and 36% with regurgitation responded to PPIs (p < 0.05). At multivariate analysis, pathological MNBI or PSPW index were associated with PPI responsiveness in patients with NCCP or heartburn, while in patients with regurgitation, pathological MNBI was associated with PPI responsiveness and a reflux number >80 to PPI refractoriness. We highlight the usefulness of an accurate clinical and functional evaluation of GERD patients, allowing to discriminate particular characteristics in patients with dominant heartburn, NCCP, or regurgitation, which may benefit of distinct therapeutic strategies.
Sections du résumé
BACKGROUND
BACKGROUND
Gastro-esophageal reflux disease (GERD) is the most common cause for noncardiac chest pain (NCCP), with an estimated prevalence rate ranging between 30% and 60%. Heartburn and NCCP may share common mechanisms.
AIMS/METHODS
OBJECTIVE
To assess whether particular patterns of impedance-pH variables characterize patients with dominant heartburn, regurgitation, or NCCP and their ability to predict proton pump inhibitor (PPI) response for each symptom, GERD patients, evaluated with high-resolution manometry (HRM) and impedance-pH, were included.
RESULTS
RESULTS
In total, 109 NCCP, 68 heartburn, and 64 regurgitation patients were included. Pathological reflux episodes were observed in 28%, 19%, and 56% (p < 0.001). Pathological mean nocturnal baseline impedance (MNBI) values were observed in 55%, 53%, and 34% (p < 0.05). Hypomotility was more frequent in NCCP compared to heartburn patients (p < 0.05). When comparing NCCP with heartburn, hypomotility was associated with NCCP perception (OR: 2.34, 95% CI: 1.23-4.43; p < 0.01). When comparing NCCP with regurgitation, >80 refluxes and type 2/3 esophagogastric junction (EGJ) were associated with regurgitation perception (OR: 0.31, 95% CI: 0.16-0.59; p < 0.001, and OR: 0.5, 95% CI: 0.27-0.93; p < 0.05), while pathological MNBI was associated with NCCP perception (OR: 2.34, 95% CI: 1.23-4.43; p < 0.01). 45.5% NCCP patients, 45.6% with heartburn, and 36% with regurgitation responded to PPIs (p < 0.05). At multivariate analysis, pathological MNBI or PSPW index were associated with PPI responsiveness in patients with NCCP or heartburn, while in patients with regurgitation, pathological MNBI was associated with PPI responsiveness and a reflux number >80 to PPI refractoriness.
CONCLUSIONS
CONCLUSIONS
We highlight the usefulness of an accurate clinical and functional evaluation of GERD patients, allowing to discriminate particular characteristics in patients with dominant heartburn, NCCP, or regurgitation, which may benefit of distinct therapeutic strategies.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e14953Informations de copyright
© 2024 John Wiley & Sons Ltd.
Références
Yamasaki T, Fass R. Noncardiac chest pain: diagnosis and management. Curr Opin Gastroenterol. 2017;33(4):293‐300.
Fass R, Achem SR. Noncardiac chest pain: epidemiology, natural course and pathogenesis. J Neurogastroenterol Motil. 2011;17:110‐123.
Eslick GD, Talley NJ. Noncardiac chest pain: predictors of healthcare seeking, the types of healthcare professional consulted, work absenteeism and interruption of daily activities. Aliment Pharmacol Ther. 2004;20:909‐915.
Park SH, Choi JY, Park EJ, et al. Prevalence of gastrointestinal diseases and treatment status in noncardiac chest pain patients. Korean Circ J. 2015;45:469‐472.
van Handel D, Fass R. The pathophysiology of non‐cardiac chest pain. J Gastroenterol Hepatol. 2005;20(Suppl):S6‐S13.
Matthews PJ, Aziz Q, Facer P, Davis JB, Thompson DG, Anand P. Increased capsaicin receptor TRPV1 nerve fibres in the inflamed human oesophagus. Eur J Gastroenterol Hepatol. 2004;16(9):897‐902.
Hu WH, Martin CJ, Talley NJ. Intraesophageal acid perfusion sensitizes the esophagus to mechanical distension: a Barostat study. Am J Gastroenterol. 2000;95(9):2189‐2194.
Min YW, Choi K, Pyo JH, Son HJ, Rhee PL. Impaired esophageal mucosal integrity may play a causative role in patients with non gastroesophageal reflux disease related noncardiac chest pain. Medicine. 2015;94:e2295.
Dekel R, Pearson T, Wendel C, de Garmo P, Fennerty MB, Fass R. Assessment of oesophageal motor function in patients with dysphagia or chest pain: the clinical outcomes research initiative experience. Aliment Pharmacol Ther. 2003;18:1083‐1089.
Rencoret G, Csendes A, Henrı'quez A. Esophageal manometry in patients with non cardiac chest pain. Rev Med Chile. 2006;134:291‐298.
Ribolsi M, Balestrieri P, Biasutto D, Emerenziani S, Cicala M. Role of mixed reflux and hypomotility with delayed reflux clearance in patients with noncardiac chest pain. J Neurogastroenterol Motil. 2016;22:606‐612.
Herregods TVK, Bredenoord AJ, Oors JM, Bogte A, Smout AJPM. Determinants of the association between non‐cardiac chest pain and reflux. Am J Gastroenterol. 2017;112(11):1671‐1677.
Min YW, Choi K, Pyo JH, Son HJ, Rhee PL. Impaired esophageal mucosal integrity may play a causative role in patients with nongastroesophageal reflux disease‐related noncardiac chest pain. Medicine. 2015;94(51):e2295.
Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R, the Global Consensus Group. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence‐based consensus. Am J Gastroenterol. 2006;101:1900‐1920. quiz 1943.
Savarino E, Pohl D, Zentilin P, et al. Functional heartburn has more in common with functional dyspepsia than with non‐erosive reflux disease. Gut. 2009;58:1185‐1191.
Savarino E, Frazzoni M, Marabotto E, et al. A SIGE‐SINGEM‐AIGO technical review on the clinical use of esophageal reflux monitoring. Dig Liver Dis. 2020;52(9):966‐980.
Savarino E, de Bortoli N, Bellini M, et al. Practice guidelines on the use of esophageal manometry—a GISMAD‐SIGE‐AIGO medical position statement. Dig Liver Dis. 2016;48:1124‐1135.
Yadlapati R, Kahrilas PJ, Fox MR, et al. Esophageal motility disorders on high‐resolution manometry: Chicago classification version 4.0. Neurogastroenterol Motil. 2021;33(1):e14058.
Ribolsi M, Emerenziani S, Petitti T, Addarii MC, Balestrieri P, Cicala M. Increased frequency and enhanced perception of reflux in non‐erosive reflux disease patients non‐responders to proton pump inhibitors. Dig Liver Dis. 2012;44:549‐554.
Savarino E, de Bortoli N, Zentilin P, et al. Alginate controls heartburn in patients with erosive and nonerosive reflux disease. World J Gastroenterol. 2012;18(32):4371‐4378.
Gyawali CP, Kahrilas PJ, Savarino E, et al. Modern diagnosis of GERD: the Lyon consensus. Gut. 2018;67:1351‐1362.
Roman S, Gyawali CP, Savarino E, et al. Ambulatory reflux monitoring for diagnosis of gastro‐esophageal reflux disease: update of the Porto consensus and recommendations from an international consensus group. Neurogastroenterol Motil. 2017;29:1‐15.
Weusten BL, Roelofs JM, Akkermans LM, et al. The symptom‐association probability: an improved method for symptom analysis of 24‐hour esophageal pH data. Gastroenterology. 1994;107:1741‐1745.
Ribolsi M, Savarino E, Frazzoni M, Cicala M. Prospective validation of reflux monitoring by impedance‐pH in predicting PPI response in typical GERD. Dig Liver Dis. 2023;55(6):721‐726.
Frazzoni L, Frazzoni M, De Bortoli N, et al. Application of Lyon consensus criteria for GORD diagnosis: evaluation of conventional and new impedance‐pH parameters. Gut. 2022;71(6):1062‐1067.
Ribolsi M, Frazzoni M, Cicala M, Savarino E. Association between post‐reflux swallow‐induced peristaltic wave index and esophageal mucosal integrity in patients with GERD symptoms. Neurogastroenterol Motil. 2023;35(1):e14344.
Ribolsi M, Perrone G, Caviglia R, et al. Intercellular space diameters of the oesophageal epithelium in NERD patients: head to head comparison between light and electron microscopy analysis. Dig Liver Dis. 2009;41(1):9‐14.
Ribolsi M, Emerenziani S, Borrelli O, et al. Impedance baseline and reflux perception in responder and non‐responder non‐erosive reflux disease patients. Scand J Gastroenterol. 2012;47(11):1266‐1273.
Gyawali CP, Yadlapati R, Fass R, et al. Updates to the modern diagnosis of GERD: Lyon consensus 2.0. Gut. 2024;73(2):361‐371.
Ribolsi M, Gyawali CP, Savarino E, et al. Correlation between reflux burden, peristaltic function, and mucosal integrity in GERD patients. Neurogastroenterol Motil. 2020;32(3):e13752.
Ribolsi M, Marchetti L, Savarino E, Gyawali CP, Cicala M. Chicago Classification v4.0 stratifies acid burden and abnormal impedance‐pH variables better than Chicago Classification v3.0 Chicago Classification v4.0 and GERD. Am J Gastroenterol. 2023;119:206‐209. doi:10.14309/ajg.0000000000002491
Ribolsi M, Savarino E, Rogers B, et al. Patients with definite and inconclusive evidence of reflux according to Lyon consensus display similar motility and esophagogastric junction characteristics. J Neurogastroenterol Motil. 2021;27(4):565‐573.
Rogers BD, Rengarajan A, Ribolsi M, et al. Postreflux swallow‐induced peristaltic wave index from pH‐impedance monitoring associates with esophageal body motility and esophageal acid burden. Neurogastroenterol Motil. 2021;33(2):e13973.
Ribolsi M, Savarino E, Rogers B, et al. High‐resolution manometry determinants of refractoriness of reflux symptoms to proton pump inhibitor therapy. J Neurogastroenterol Motil. 2020;26(4):447‐454.
Rogers BD, Rengarajan A, Mauro A, et al. Fragmented and failed swallows on esophageal high‐resolution manometry associate with abnormal reflux burden better than weak swallows. Neurogastroenterol Motil. 2020;32(2):e13736.
Kahrilas PJ, Howden CW, Hughes N. Response of regurgitation to proton pump inhibitor therapy in clinical trials of gastroesophageal reflux disease. Am J Gastroenterol. 2011;106(8):1419‐1425.
Zerbib F, Bredenoord AJ, Fass R, et al. ESNM/ANMS consensus paper: diagnosis and management of refractory gastro‐esophageal reflux disease. Neurogastroenterol Motil. 2021;33(4):e14075.
Eslick GD, Talley NJ. Non‐cardiac chest pain: predictors of health care seeking, the types of health care professional consulted, work absenteeism and interruption of daily activities. Aliment Pharmacol Ther. 2004;20:909‐915.