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World J Gastroenterol. Nov 14, 2008; 14(42): 6506-6512
Published online Nov 14, 2008. doi: 10.3748/wjg.14.6506
Origin of and therapeutic approach to cardiac syndrome X: Results of the proton pump inhibitor therapy for angina-like lingering pain trial (PITFALL trial)
Christoph G Dietrich, Susanne Laupichler, Sven Stanzel, Ron Winograd, Oliver Al-Taie, Carsten Gartung, Andreas Geier
Christoph G Dietrich, Susanne Laupichler, Ron Winograd, Carsten Gartung, Andreas Geier, Department of Gastroenterology, Aachen University, Aachen 52074, Germany
Christoph G Dietrich, Oliver Al-Taie, Department of Gastroenterology, Klinikum Aschaffenburg, Aschaffenburg 63739, Germany
Sven Stanzel, Department of Medical Statistics, Aachen University, Aachen 52074, Germany
Andreas Geier, Department of Gastroenterology, University Hospital Zurich, Zurich 8091, Switzerland
Author contributions: Dietrich CG and Geier A designed the study, wrote the study protocol and supervised diagnostic procedures and treatment of all patients; Laupichler S organized patient inclusion and did the telephone interviews; Winograd R conducted most of the medical investigations; Stanzel S did the statistical analysis of the study; Al-Taie O and Gartung C contributed to design and data interpretation; all authors contributed to writing the manuscript.
Correspondence to: Andreas Geier, MD, Division of Gastroenterology and Hepatology, University Hospital Zurich, Rämistr. 100, Zurich 8091, Switzerland. andreas.geier@usz.ch
Telephone: +41-44-2552259 Fax: +41-44-2554503
Received: May 6, 2008
Revised: June 30, 2008
Accepted: July 7, 2008
Published online: November 14, 2008
Abstract

AIM: To investigate the frequency of gastroen-terological diseases in the etiology and the efficacy of proton pump inhibitors (PPIs) in the treatment of cardiac syndrome X (CSX) as a subform of non-cardiac chest pain (NCCP).

METHODS: We investigated 114 patients with CSX using symptom questionnaires. A subgroup of these patients were investigated regarding upper gastrointestinal disorders (GIs) and treated with PPI. Patients not willing to participate in investigation and treatment served as control group.

RESULTS: Thirty-six patients denied any residual symptoms and were not further evaluated. After informed consent in 27 of the remaining 78 patients, we determined the prevalence of disorders of the upper GI tract and quantified the effect of treatment with pantoprazole. We found a high prevalence of gastroenterological pathologies (26/27 patients, 97%) with gastritis, gastroesophageal reflux disease (GERD) and acid reflux as the most common associated disorders. If treated according to the study protocol, these patients showed a significant improvement in the symptom score. Patients treated by primary care physicians, not according to the study protocol had a minor response to treatment (n = 19, -43%), while patients not treated at all (n = 26) had no improvement of symptoms (-0%).

CONCLUSION: Disorders of the upper GI tract are a frequent origin of CSX in a German population and can be treated with pantoprazole if given for a longer period.

Keywords: Non-cardiac chest pain; Gastroesophageal reflux disease; Proton pump inhibitor; Cardiac syndrome X