Esophageal chest pain resembles heartburn in reflux metrics and response to proton pump inhibitor therapy

Mentore Ribolsi; Lorenzo Marchetti; Lucrezia Maria Olmi; Michele Cicala; Edoardo Savarino

doi:10.1111/nmo.14953

Esophageal chest pain resembles heartburn in reflux metrics and response to proton pump inhibitor therapy

Neurogastroenterol Motil. 2024 Nov 1:e14953. doi: 10.1111/nmo.14953. Online ahead of print.

Authors

Mentore Ribolsi¹, Lorenzo Marchetti¹, Lucrezia Maria Olmi¹, Michele Cicala¹, Edoardo Savarino²

Affiliations

¹ Department of Digestive Diseases, Campus Bio Medico University of Rome, Rome, Italy.
² Division of Gastroenterology, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy.

PMID: 39485991
DOI: 10.1111/nmo.14953

Abstract

Background: Gastro-esophageal reflux disease (GERD) is the most common cause for noncardiac chest pain (NCCP), with an estimated prevalence rate ranging between 30% and 60%. Heartburn and NCCP may share common mechanisms.

Aims/methods: To assess whether particular patterns of impedance-pH variables characterize patients with dominant heartburn, regurgitation, or NCCP and their ability to predict proton pump inhibitor (PPI) response for each symptom, GERD patients, evaluated with high-resolution manometry (HRM) and impedance-pH, were included.

Results: In total, 109 NCCP, 68 heartburn, and 64 regurgitation patients were included. Pathological reflux episodes were observed in 28%, 19%, and 56% (p < 0.001). Pathological mean nocturnal baseline impedance (MNBI) values were observed in 55%, 53%, and 34% (p < 0.05). Hypomotility was more frequent in NCCP compared to heartburn patients (p < 0.05). When comparing NCCP with heartburn, hypomotility was associated with NCCP perception (OR: 2.34, 95% CI: 1.23-4.43; p < 0.01). When comparing NCCP with regurgitation, >80 refluxes and type 2/3 esophagogastric junction (EGJ) were associated with regurgitation perception (OR: 0.31, 95% CI: 0.16-0.59; p < 0.001, and OR: 0.5, 95% CI: 0.27-0.93; p < 0.05), while pathological MNBI was associated with NCCP perception (OR: 2.34, 95% CI: 1.23-4.43; p < 0.01). 45.5% NCCP patients, 45.6% with heartburn, and 36% with regurgitation responded to PPIs (p < 0.05). At multivariate analysis, pathological MNBI or PSPW index were associated with PPI responsiveness in patients with NCCP or heartburn, while in patients with regurgitation, pathological MNBI was associated with PPI responsiveness and a reflux number >80 to PPI refractoriness.

Conclusions: We highlight the usefulness of an accurate clinical and functional evaluation of GERD patients, allowing to discriminate particular characteristics in patients with dominant heartburn, NCCP, or regurgitation, which may benefit of distinct therapeutic strategies.

Keywords: GERD; HRM; heartburn; impedance‐pH; noncardiac chest pain; regurgitation.