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Proton pump inhibitor and selective serotonin reuptake inhibitor therapy for the management of noncardiac chest pain

Viazis, Nikosa; Katopodi, Konstantinaa; Karamanolis, Georgeb; Denaxas, Konstantinosb; Varytimiadis, Lazarosa; Galanopoulos, Michaila; Tsoukali, Emmanouelaa; Kamberoglou, Dimitirsb; Christidou, Angelikib; Karamanolis, Dimitrios G.a; Papatheodoridis, Georgeb; Mantzaris, Gerasimos J.a

European Journal of Gastroenterology & Hepatology: September 2017 - Volume 29 - Issue 9 - p 1054–1058
doi: 10.1097/MEG.0000000000000925
Original Articles: Gastro-esophageal Disorders

Introduction Although gastroesophageal reflux disease is the main cause of noncardiac chest pain (NCCP), proton pump inhibitors (PPIs) benefit a minority of patients. Our prospective study evaluated the effect of PPI and selective serotonin reuptake inhibitors on the different subtypes of NCCP characterized by impedance-pH monitoring.

Methods All NCCP patients underwent impedance-pH monitoring and on the basis of the results, those with abnormal distal esophageal acid exposure received PPIs twice daily (group A), those with a positive symptom index for chest pain received citalopram 20 mg and PPI once daily (group B), and those with a negative symptom index for chest pain received citalopram 20 mg once daily (group C). Therapy was administered for 12 weeks and treatment success was defined as complete disappearance of chest pain.

Results From March 2015 to March 2016, 63 patients were included (group A=9, group B=18, group C=36). After 12 weeks of therapy, complete resolution of chest pain was noted in 8/9 (88.9%) group A, 13/18 (72.2%) group B, and 24/36 (66.7%) group C patients.

Conclusion Combined impedance-pH monitoring identifies different subtypes of NCCP patients who can receive tailored management. Targeted therapy with PPIs and/or citalopram offers complete symptom relief in the great majority of them.

aDepartment of Gastroenterology, Evangelismos Hospital

bAcademic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece

Correspondence to Nikos Viazis, MD, Department of Gastroenterology, Evangelismos Hospital, 31st street, Number 11, Elliniko, 16777 Athens, Greece Tel: +30 213 204 1609; fax: +30 213 204 1634; e-mail:

Received January 21, 2017

Accepted May 24, 2017

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.