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LOS ANGELES — Nearly 30% of patients with noncardiac chest pain had a diagnosis of hiatal hernia and almost 20% had esophageal erosions when they underwent upper endoscopy as part of their work-ups at 76 community, university, and Veterans Affairs and military hospitals.
“Unlike what is commonly accepted, esophageal findings are relatively common in patients with noncardiac chest pain,” Dr. Ram Dickman said at the annual Digestive Disease Week.
Previous thinking about the prevalence of esophageal findings in patients with noncardiac chest pain (NCCP) was guided by one study representing a single center's experience. In that study, fewer than 10% of NCCP patients had esophageal findings on upper endoscopy, said Dr. Dickman of the Neuro-Enteric Clinical Research Group in the gastroenterology section at the Southern Arizona VA Health Care System and University of Arizona Health Sciences Center, Tucson.
To offer a more representative analysis, Dr. Dickman and his associates retrospectively compared the endoscopic results of 3,688 consecutive patients undergoing upper endoscopy for NCCP with the records of 32,981 consecutive patients who underwent the same examination for reflux symptoms.
The NCCP group included more female patients, nonwhites, and patients aged 60 or older.
As expected, patients with reflux symptoms were significantly more likely to have esophageal findings on endoscopy. Barrett's esophagus was more than twice as prevalent in reflux patients and esophageal erosion was 1.5 times as common, compared with patients with NCCP.
Indeed, the most common finding on endoscopy reports for NCCP patients was “normal,” seen in 44%.
Nonetheless, among patients with NCCP, hiatal hernia was found in 28.6%, esophageal erosion in 19.4%, Barrett's esophagus in 4.4%, and stricture or stenosis in 3.6%. Upper gastrointestinal tract tumors were found in just 0.2% of the NCCP patients, with a similarly low rate found in patients with reflux symptoms.
The decision to scope a patient with NCCP may be guided by predictive risk factors, and whether a certain findings would alter management of the patient, Dr. Dickman said.
For example, males and VA or military hospital patients with NCCP had an increased likelihood of having Barrett's esophagus, and male gender was also a risk factor for esophageal erosions. Older patients and those seen in a VA or military hospital were more likely to have a peptic stricture.
LOS ANGELES — Nearly 30% of patients with noncardiac chest pain had a diagnosis of hiatal hernia and almost 20% had esophageal erosions when they underwent upper endoscopy as part of their work-ups at 76 community, university, and Veterans Affairs and military hospitals.
“Unlike what is commonly accepted, esophageal findings are relatively common in patients with noncardiac chest pain,” Dr. Ram Dickman said at the annual Digestive Disease Week.
Previous thinking about the prevalence of esophageal findings in patients with noncardiac chest pain (NCCP) was guided by one study representing a single center's experience. In that study, fewer than 10% of NCCP patients had esophageal findings on upper endoscopy, said Dr. Dickman of the Neuro-Enteric Clinical Research Group in the gastroenterology section at the Southern Arizona VA Health Care System and University of Arizona Health Sciences Center, Tucson.
To offer a more representative analysis, Dr. Dickman and his associates retrospectively compared the endoscopic results of 3,688 consecutive patients undergoing upper endoscopy for NCCP with the records of 32,981 consecutive patients who underwent the same examination for reflux symptoms.
The NCCP group included more female patients, nonwhites, and patients aged 60 or older.
As expected, patients with reflux symptoms were significantly more likely to have esophageal findings on endoscopy. Barrett's esophagus was more than twice as prevalent in reflux patients and esophageal erosion was 1.5 times as common, compared with patients with NCCP.
Indeed, the most common finding on endoscopy reports for NCCP patients was “normal,” seen in 44%.
Nonetheless, among patients with NCCP, hiatal hernia was found in 28.6%, esophageal erosion in 19.4%, Barrett's esophagus in 4.4%, and stricture or stenosis in 3.6%. Upper gastrointestinal tract tumors were found in just 0.2% of the NCCP patients, with a similarly low rate found in patients with reflux symptoms.
The decision to scope a patient with NCCP may be guided by predictive risk factors, and whether a certain findings would alter management of the patient, Dr. Dickman said.
For example, males and VA or military hospital patients with NCCP had an increased likelihood of having Barrett's esophagus, and male gender was also a risk factor for esophageal erosions. Older patients and those seen in a VA or military hospital were more likely to have a peptic stricture.
LOS ANGELES — Nearly 30% of patients with noncardiac chest pain had a diagnosis of hiatal hernia and almost 20% had esophageal erosions when they underwent upper endoscopy as part of their work-ups at 76 community, university, and Veterans Affairs and military hospitals.
“Unlike what is commonly accepted, esophageal findings are relatively common in patients with noncardiac chest pain,” Dr. Ram Dickman said at the annual Digestive Disease Week.
Previous thinking about the prevalence of esophageal findings in patients with noncardiac chest pain (NCCP) was guided by one study representing a single center's experience. In that study, fewer than 10% of NCCP patients had esophageal findings on upper endoscopy, said Dr. Dickman of the Neuro-Enteric Clinical Research Group in the gastroenterology section at the Southern Arizona VA Health Care System and University of Arizona Health Sciences Center, Tucson.
To offer a more representative analysis, Dr. Dickman and his associates retrospectively compared the endoscopic results of 3,688 consecutive patients undergoing upper endoscopy for NCCP with the records of 32,981 consecutive patients who underwent the same examination for reflux symptoms.
The NCCP group included more female patients, nonwhites, and patients aged 60 or older.
As expected, patients with reflux symptoms were significantly more likely to have esophageal findings on endoscopy. Barrett's esophagus was more than twice as prevalent in reflux patients and esophageal erosion was 1.5 times as common, compared with patients with NCCP.
Indeed, the most common finding on endoscopy reports for NCCP patients was “normal,” seen in 44%.
Nonetheless, among patients with NCCP, hiatal hernia was found in 28.6%, esophageal erosion in 19.4%, Barrett's esophagus in 4.4%, and stricture or stenosis in 3.6%. Upper gastrointestinal tract tumors were found in just 0.2% of the NCCP patients, with a similarly low rate found in patients with reflux symptoms.
The decision to scope a patient with NCCP may be guided by predictive risk factors, and whether a certain findings would alter management of the patient, Dr. Dickman said.
For example, males and VA or military hospital patients with NCCP had an increased likelihood of having Barrett's esophagus, and male gender was also a risk factor for esophageal erosions. Older patients and those seen in a VA or military hospital were more likely to have a peptic stricture.