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Pathological bolus exposure plays a significant role in eliciting non-cardiac chest pain

Authors
Kim, Beom JinChoi, Sung ChulKim, Jae J.Rhee, Jong ChulRhee, Poong-Lyul
Issue Date
Dec-2010
Publisher
WILEY
Keywords
combined impedance-pH monitoring; non-cardiac chest pain; pathological bolus exposure
Citation
JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, v.25, no.12, pp 1855 - 1860
Pages
6
Journal Title
JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY
Volume
25
Number
12
Start Page
1855
End Page
1860
URI
https://scholarworks.bwise.kr/cau/handle/2019.sw.cau/22040
DOI
10.1111/j.1440-1746.2010.06415.x
ISSN
0815-9319
1440-1746
Abstract
Background and Aim: Pathological bolus exposure is defined in the present study as cases in which all reflux percentage times are above 1.4% of the total reflux number, as revealed by impedance-pH monitoring. The role of pathological bolus exposure in the pathogenesis of non-cardiac chest pain (NCCP) is poorly known. We aimed to classify and characterize NCCP using combined impedance-pH monitoring. Methods: Seventy-five consecutive patients with NCCP were prospectively enrolled from January 2006 to October 2008. All the patients underwent upper endoscopy, esophageal manometry, and 24-h multichannel intraluminal impedance (MII)-pH metering. Results: Sixteen patients (21.3%) had esophageal erosion upon endoscopy. Upon esophageal manometry, 37 patients (49.3%) had esophageal dysmotility. When the patients were classified based on MII-pH metering, 16 (21.3%) showed pathological acid exposure, and 40 (53.3%) showed pathological bolus exposure. The DeMeester score of patients with pathological acid exposure was higher than that of patients with pathological bolus exposure (P = 0.002). There was no significant difference in age, sex, typical esophageal symptoms, presence of esophageal erosion, esophageal dysmotility, improvement with proton pump inhibitor medication, symptom index >= 50%, percentage of time clearance pH below 4 >= 4%, and all reflux time >= 1.4% in the fasting period between the two groups. When the patients were divided into gastroesophageal reflux disease (GERD)-related NCCP and non-GERD-related NCCP groups based on MII-pH metering and upper endoscopy, there was no difference between the two groups. Conclusions: Combined impedance-pH monitoring improves the detection and characterization of NCCP. This study suggests that pathological bolus exposure plays a major role in eliciting NCCP.
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