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Treatment efficacy for non-cardiovascular chest pain: a systematic review and meta-analysis.

Burgstaller JM, Jenni BF, Steurer J, Held U, Wertli MM - PLoS ONE (2014)

Bottom Line: PPI treatment in patients with GERD (5 RCTs, 192 patients) was more effective than placebo [pooled OR 11.7 (95% CI 5.5 to 25.0, heterogeneity I2 = 6.1%)].In musculoskeletal NCCP (2 RCTs, 229 patients) manual therapy was more effective than usual care but not than home exercise [pooled mean difference 0.5 (95% CI -0.3 to 1.3, heterogeneity I2 = 46.2%)].For patients with suspected GERD, high-dose treatment with PPI is effective.

View Article: PubMed Central - PubMed

Affiliation: Horten Center for Patient Oriented Research and Knowledge Transfer, Department of Internal Medicine, University of Zurich, Zurich, Switzerland.

ABSTRACT

Background: Non-cardiovascular chest pain (NCCP) leads to impaired quality of life and is associated with a high disease burden. Upon ruling out cardiovascular disease, only vague recommendations exist for further treatment.

Objectives: To summarize treatment efficacy for patients presenting with NCCP.

Methods: Systematic review and meta-analysis. In July 2013, Medline, Web of Knowledge, Embase, EBSCOhost, Cochrane Reviews and Trials, and Scopus were searched. Hand and bibliography searches were also conducted. Randomized controlled trials (RCTs) evaluating non-surgical treatments in patients with NCCP were included. Exclusion criteria were poor study quality and small sample size (<10 patients per group).

Results: Thirty eligible RCT's were included. Most studies assessed PPI efficacy for gastroesophageal reflux disorders (GERD, n = 10). Two RCTs included musculoskeletal chest pain, seven psychotropic drugs, and eleven various psychological interventions. Study quality was high in five RCTs and acceptable in 25. PPI treatment in patients with GERD (5 RCTs, 192 patients) was more effective than placebo [pooled OR 11.7 (95% CI 5.5 to 25.0, heterogeneity I2 = 6.1%)]. The pooled OR in GERD negative patients (4 RCTs, 156 patients) was 0.8 (95% CI 0.2 to 2.8, heterogeneity I2 = 50.4%). In musculoskeletal NCCP (2 RCTs, 229 patients) manual therapy was more effective than usual care but not than home exercise [pooled mean difference 0.5 (95% CI -0.3 to 1.3, heterogeneity I2 = 46.2%)]. The findings for cognitive behavioral treatment, serotonin reuptake inhibitors, tricyclic antidepressants were mixed. Most evidence was available for cognitive behavioral treatment interventions.

Limitations: Only a small number of studies were available.

Conclusions: Timely diagnostic evaluation and treatment of the disease underlying NCCP is important. For patients with suspected GERD, high-dose treatment with PPI is effective. Only limited evidence was available for most prevalent diseases manifesting with chest pain. In patients with idiopathic NCCP, treatments based on cognitive behavioral principles might be considered.

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Related in: MedlinePlus

Efficacy of Proton Pump Inhibitor (PPI) treatment in patients with NCCP.
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pone-0104722-g002: Efficacy of Proton Pump Inhibitor (PPI) treatment in patients with NCCP.

Mentions: Only similar RCTs (n = 7, 771 patients) were included in the meta-analysis (Figure 2). A PPI was administered in most RCTs twice daily for 1 to 8 weeks. In two RCTs, GERD-positive and GERD-negative patients were not distinguished [30], [32]; in both of these studies, the efficacy of treatment was more effective than placebo. The pooled odds ratio for a reduction in chest pain of ≥50% was 4.2 (95% CI 2.7 to 6.7, heterogeneity I2 = 26.6%).


Treatment efficacy for non-cardiovascular chest pain: a systematic review and meta-analysis.

Burgstaller JM, Jenni BF, Steurer J, Held U, Wertli MM - PLoS ONE (2014)

Efficacy of Proton Pump Inhibitor (PPI) treatment in patients with NCCP.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4128723&req=5

pone-0104722-g002: Efficacy of Proton Pump Inhibitor (PPI) treatment in patients with NCCP.
Mentions: Only similar RCTs (n = 7, 771 patients) were included in the meta-analysis (Figure 2). A PPI was administered in most RCTs twice daily for 1 to 8 weeks. In two RCTs, GERD-positive and GERD-negative patients were not distinguished [30], [32]; in both of these studies, the efficacy of treatment was more effective than placebo. The pooled odds ratio for a reduction in chest pain of ≥50% was 4.2 (95% CI 2.7 to 6.7, heterogeneity I2 = 26.6%).

Bottom Line: PPI treatment in patients with GERD (5 RCTs, 192 patients) was more effective than placebo [pooled OR 11.7 (95% CI 5.5 to 25.0, heterogeneity I2 = 6.1%)].In musculoskeletal NCCP (2 RCTs, 229 patients) manual therapy was more effective than usual care but not than home exercise [pooled mean difference 0.5 (95% CI -0.3 to 1.3, heterogeneity I2 = 46.2%)].For patients with suspected GERD, high-dose treatment with PPI is effective.

View Article: PubMed Central - PubMed

Affiliation: Horten Center for Patient Oriented Research and Knowledge Transfer, Department of Internal Medicine, University of Zurich, Zurich, Switzerland.

ABSTRACT

Background: Non-cardiovascular chest pain (NCCP) leads to impaired quality of life and is associated with a high disease burden. Upon ruling out cardiovascular disease, only vague recommendations exist for further treatment.

Objectives: To summarize treatment efficacy for patients presenting with NCCP.

Methods: Systematic review and meta-analysis. In July 2013, Medline, Web of Knowledge, Embase, EBSCOhost, Cochrane Reviews and Trials, and Scopus were searched. Hand and bibliography searches were also conducted. Randomized controlled trials (RCTs) evaluating non-surgical treatments in patients with NCCP were included. Exclusion criteria were poor study quality and small sample size (<10 patients per group).

Results: Thirty eligible RCT's were included. Most studies assessed PPI efficacy for gastroesophageal reflux disorders (GERD, n = 10). Two RCTs included musculoskeletal chest pain, seven psychotropic drugs, and eleven various psychological interventions. Study quality was high in five RCTs and acceptable in 25. PPI treatment in patients with GERD (5 RCTs, 192 patients) was more effective than placebo [pooled OR 11.7 (95% CI 5.5 to 25.0, heterogeneity I2 = 6.1%)]. The pooled OR in GERD negative patients (4 RCTs, 156 patients) was 0.8 (95% CI 0.2 to 2.8, heterogeneity I2 = 50.4%). In musculoskeletal NCCP (2 RCTs, 229 patients) manual therapy was more effective than usual care but not than home exercise [pooled mean difference 0.5 (95% CI -0.3 to 1.3, heterogeneity I2 = 46.2%)]. The findings for cognitive behavioral treatment, serotonin reuptake inhibitors, tricyclic antidepressants were mixed. Most evidence was available for cognitive behavioral treatment interventions.

Limitations: Only a small number of studies were available.

Conclusions: Timely diagnostic evaluation and treatment of the disease underlying NCCP is important. For patients with suspected GERD, high-dose treatment with PPI is effective. Only limited evidence was available for most prevalent diseases manifesting with chest pain. In patients with idiopathic NCCP, treatments based on cognitive behavioral principles might be considered.

Show MeSH
Related in: MedlinePlus