Introduction Non-cardiac chest pain (NCCP) is a common cause for referral to gastroenterology. Following the exclusion of a cardiac cause, NCCP is attributed to a variety of disorders, including gastroesophageal reflux disease (GORD), oesophageal dysmotility and oesophageal hypersensitivity, panic attack, musculoskeletal pain, and microvascular disease (cardiac syndrome X). GORD is the most prevalent cause of NCCP, accounting for up to 60% of cases. The prevalence of GORD in NCCP has been studied by pH monitoring and found to be 41% to 43%.
Methods The aim of this study was to assess the diagnostic yield of gastroscopy as a first line investigation in the management of patients with NCCP. A retrospective analysis from September 2000–March 2013 of the endoscopic findings (using the Endoscribe and unisoft endoscopy reporting system) along with patient case notes, of consecutive patients with NCCP undergoing gastroscopy, in a district general hospital in North London was undertaken.
Results A total of 146 patients (age range was 21 to 93 years with a male to female ratio of 68:78) were identified as having had an upper GI endoscopy for chest pain alone. 49/146 (34%) patients had a normal gastroscopy, 29/146 (20%) had evidence of GORD (oesophagitis, peptic stricture, Barrett’s oesophagus or hiatus, hernia), 27 patients (18%) had gastritis, and 11 (7%) with oesophageal motility disorders. Other findings included: 9 patients with duodenitis, 1 with gastric ulcer, 1 with oesophageal ulcer, 2 with gastric polyp.
Conclusion In this study, the diagnostic yield of gastroscopy as to a oesophageal cause of NCCP is poor. 73% of patients with NCCP had a normal or incidencal benign non-contributory findings at endoscopy. Only 27% of patients had evidence of GORD or oesophageal dysmotility. The majority of these could have been diagnosed by high dose acid suppression therapy trial. We conclude that endoscopy in patients presenting to gastroenterology with NCCP is not a cost effective diagnostic tool and would suggest other modalities such as high dose proton pump inhibitor trial, barium swallow or oesophageal manometry/pH testing be explored as first line investigations.
Disclosure of Interest None Declared.
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