Contributed equally to this work.
Symptomatic response to lansoprazole predicts abnormal acid reflux in endoscopy-negative patients with non-cardiac chest pain
Article first published online: 4 FEB 2003
Alimentary Pharmacology & Therapeutics
Volume 17, Issue 3, pages 369–377, February 2003
How to Cite
Xia, H. H. X., Lai, K. C., Lam, S. K., Hu, W. H. C., Wong, N. Y. H., Hui, W. M., Lau, C. P., Chen, W. H., Chan, C. K., Wong, W. M. and Wong, B. C. Y. (2003), Symptomatic response to lansoprazole predicts abnormal acid reflux in endoscopy-negative patients with non-cardiac chest pain. Alimentary Pharmacology & Therapeutics, 17: 369–377. doi: 10.1046/j.1365-2036.2003.01436.x
- Issue published online: 4 FEB 2003
- Article first published online: 4 FEB 2003
- Accepted for publication 8 October 2002
Aim : To determine whether symptomatic response to lansoprazole predicts abnormal acid reflux in endoscopy-negative patients with non-cardiac chest pain.
Methods : Patients who complained of chest pain, but had normal coronary angiography, were asked to undergo upper endoscopy. Those without gastric and oesophageal lesions were recruited for 24-h ambulatory oesophageal pH monitoring, and were randomly given lansoprazole 30 mg or placebo, both daily for 4 weeks. Chest pain symptoms were recorded before and 1 month after treatment on a locally validated questionnaire. The symptom score was calculated by multiplying the severity and frequency of the symptom, and symptom improvement was defined as > 50% reduction in symptom score.
Results : Overall, 68 patients, 36 on lansoprazole and 32 on placebo, completed the trial. The symptom score was reduced significantly in both groups (P < 0.001). In the lansoprazole group, more patients with than without abnormal reflux showed symptom improvement (92% vs. 33%; odds ratio = 22; 95% confidence interval, 2.3–201.8; χ2 = 10.9; P = 0.001), giving a sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 92%, 67%, 58%, 94% and 75%, respectively. In the placebo group, the rates of symptom improvement were similar between those with and without abnormal reflux (33% vs. 35%, P = N.S.).
Conclusions : Treatment with lansoprazole is a useful test in diagnosing endoscopy-negative gastro-oesophageal reflux disease in Chinese patients with non-cardiac chest pain.