Purpose: Noncardiac chest pain (NCCP) is a common clinical dilemma. The significance of acid and nonacid reflux in patients with noncardiac chest pain is not fully understood, especially in patients with chest pain refractory to PPI therapy.
Aim: To evaluate characteristics of acid and nonacid reflux in a cohort of patients with noncardiac chest pain referred for 24 hour impedance testing.
Methods: A retrospective chart review was performed on all 24 hour impedance studies performed at the University of Utah between December 2005 and March 2007. Patient characteristics included age, gender and proton pump inhibitor (PPI) use. Impedance data included acid and non-acid reflux events and symptom associated probabilities (SAP).
Results: 24 impedance studies were evaluated. Patient age ranged from 23 to 75 years old. 16 of the 24 patients (67%) experienced abnormal reflux. 13 of these (81%) had nonacid reflux and only 1 had a positive SAP for noncardiac chest pain. 22 of the 24 patients included in this analysis were on a PPI. 16 patients (67%) were women. 11 women experienced poor control of reflux on impedance, 9 of whom had increased amounts of nonacid reflux.
Conclusion: The role of acid and nonacid reflux in NCCP is poorly understood. This is the first data set available on the utility of impedance in NCCP. Our data shows that while 92% of the patients were on a PPI, 16 of 24 experienced poor control of reflux symptoms. Of patients with poor control of reflux symptoms, 81% experienced nonacid reflux on impedance. The SAP for patients with both good control and poor control of reflux symptoms does not correlate with the symptom of noncardiac chest pain.