Clinical Aproach To Gastroesophageal.doc

Clinical Approach To Gastroesophageal-reflux disease (GERD) presenting As Chest Pain ? Ravinder PS Makkar, MBBS, MDMedical Advisor, Department of Medical Assistance International SOS, New Delhi, India G.K. Sachdev, MBBS, MD, DM, DNB, FRCPProfessor of Medicine and Gastroenterology, Department of MedicineMaulana AzadMedical College, New Delhi, India Corresponding author E-mail: ravinder.makkar@ ? Abstract: Gastroesophageal-reflux disease (GERD) is probably the most common cause of non-cardiac chest pain in clinical practice. Most patients with GERD induced chest pain have other related symptoms (e.g. retrosternal burning, sour eructations, water brash, or regurgitation) when questioned closely, but about 10% may have only chest pain as there presenting complaint. Patients with unexplained chest pain should be considered to have a cardiac cause for their pain until proven otherwise. Coronary artery disease should be given ample consideration early in the diagnostic protocol because the implications of this diagnosis are more profound than are those of GERD. Patients with typical GERD symptoms should be evaluated by an upper GI endoscopy, while in others, tests like 24-hour pH monitoring or esophageal manometry can confirm the esophageal origin of the chest pain. When reflux is suspected as the cause, a therapeutic trial of proton pump inhibitors is appropriate. Antireflux surgery is indicated only if acid reflux is proved beyond doubt and is resistant to medical therapy. Also an important part of therapy is reassurance and careful explanation to the patient of the esophageal and not the cardiac origin of the chest pain. Key words: Atypical symptoms; chest pain; gastroesophageal reflux disease, GERD Introduction Chest pain is one of the commonest clinical complaints encountered by the general practitioners and family physicians in their clinical practice. Besides being cardiac in origin, recurrent chest pain mimicking angina pectoris can arise from the esophag