Noncardiac Chest Pain in Young Patients: Author's Reply

Abstract

TO THE EDITOR: The prevalence of noncardiac chest pain (NCCP) differs by the type of study performed: hospital-based studies, community-based studies or general practice studies. In the previous two studies,1,2 we reported that 38%-41% of NCCP in average aged subjects had gastroesophageal reflux disease (GERD) diagnosed by endoscopy and 24-hour esophageal pH monitoring, with similar protocol to this study on young aged NCCP.3 Comparing with our previous data, our present ratio of GERD-related NCCP (30%) was low, although the young age is one of the potential risk factors for NCCP.4 In this study, gastroenterologic causes such as peptic ulcer disease, gastrointestinal surgery and liver disease were excluded. Several pathophysiological mechanisms of NCCP have been suggested including GERD, esophageal motility disorders, visceral hyperalgesia and psychiatric disturbances and especially little are known about the characteristics of NCCP related to non GERD. Our data suggest that there may be more possibilities of other pathophysiological mechanisms except GERD in the young aged NCCP such as visceral hyperalgesia, psychiatric disturbances and so on. Therefore, as mentioned by the editor, management of the rest of the NCCP patients with non GERD is very important. The recent prospective case-control study by Lee et al5 suggested a new serotonin-norepinephrine reuptake inhibitor to aid in establishing the strategy for management by showing significantly improved symptoms in 52% of young adult patients with functional chest pain. In this study, typical GERD symptoms were more frequent in NCCP patients with GERD than in NCCP patients with non GERD (78% vs 29%). Therefore, typical GERD symptoms as well as proton pump inhibitor test may be a fair predictor for GERD-related NCCP in young aged patients, despite the relatively low prevalence of GERD-related NCCP. In addition, the long-term natural history of NCCP is one of our major concerns, so we need to monitor these NCCP patients more thoroughly.