Proton-pump inhibitor testing in the diagnosis of non-cardiac chest pain

Proton pump inhibitor treatment, as a diagnostic test, appears to have adequate sensitivity and specificity to detect GERD in patients with NCCP.

A systematic review including 6 studies with a total of 220 subjects was abstracted in DARE. Studies of adult patients with recurrent chest pain and with no known cardiac abnormalities, and in which the diagnosis was confirmed by endoscopy and/or 24-hour oesophageal pH monitoring were eligible for inclusion. In most studies patients used a high dose of a PPI for a maximum of 4 weeks. The pooled estimates for the sensitivity and specificity of a PPI diagnostic test were 0.80 (95% CI: 0.71 to 0.87) and 0.74 (95% CI: 0.64 to 0.83), respectively. The comparative estimates for the placebo group were 0.19 (95% CI: 0.12 to 0.29) and 0.77 (95% CI: 0.62 to 0.87), respectively. The PPI test had significantly higher overall diagnostic accuracy for diagnosing GERD in patients with NCCP than placebo: the pooled diagnostic odds ratio was 19.35 (95% CI: 8.54 to 43.84), compared with 0.61 (95% CI: 0.20 to 1.86, P=0.03).

Comment: The quality of evidence is downgraded by sparse data.

Ədəbiyyat

1. Wang WH, Huang JQ, Zheng GF, Wong WM, Lam SK, Karlberg J, Xia HH, Fass R, Wong BC. Is proton pump inhibitor testing an effective approach to diagnose gastroesophageal reflux disease in patients with noncardiac chest pain?: a meta-analysis. Arch Intern Med 2005 Jun 13;165(11):1222-8.