Original Contribution
The American Journal of Gastroenterology (2005) 100, 1226–1232; doi:10.1111/j.1572-0241.2005.41657.x
Diagnostic and Therapeutic Use of Proton Pump Inhibitors in Non-Cardiac Chest Pain: A Metaanalysis
Filippo Cremonini MD, MSc1, James Wise MD1, Paul Moayyedi PhD, FRCP1 and Nicholas J Talley MD, PhD, FACP1
1Clinical Enteric Neuroscience, Translational and Epidemiological Research Program (C.E.N.T.E.R.) and Mayo Clinic College of Medicine, Rochester, Minnesota; and Gastroenterology Division, McMaster University, Hamilton, Ontario, Canada
Correspondence: Nicholas J Talley, MD, PhD,, Mayo Clinic 200 First Street S.W. Plummer 6-56 Rochester, MN 55905.
Received 11 October 2004; Revised 0000; Accepted 15 December 2004.
Abstract
OBJECTIVES:
To assess (i) the efficacy of short-term proton pump inhibitors (PPIs) in non-cardiac chest pain (NCCP) and (ii) the performance of an empirical short-term treatment with PPI (PPI test) to establish a diagnosis of abnormal acid reflux in NCCP.
METHODS:
Metaanalysis of English language studies identified by searching MEDLINE (1966–May 2004), EMBASE (1980–May 2004), Cochrane Controlled Trials Register, and abstract books from major gastroenterology meetings (1993–2004). For the metaanalysis of PPI efficacy in NCCP, we selected randomized controlled trials (parallel group and crossover designs) comparing PPI therapy with placebo. For the metaanalysis of PPI test performance, we selected uncontrolled studies comparing the test with a standard reference.
RESULTS:
Eight studies were included in the PPI efficacy analysis. The pooled risk ratio for continued chest pain after PPI therapy was 0.54 (95% CI 0.41–0.71). The overall number needed to treat was 3 (95% CI 2–4). The pooled sensitivity, specificity, and diagnostic odds ratio for the PPI test versus 24-h pH monitoring and endoscopy were 80%, 74%, and 13.83 (95% CI 5.48–34.91), respectively. All studies were small and there was evidence of publication bias or other small study effects.
CONCLUSION:
PPI therapy reduces symptoms in NCCP and may be useful as a diagnostic test in identifying abnormal esophageal acid reflux.
