Clinical Approach on the Management for Patients with Noncardiac Chest Pain in Korea

Gastroesophageal reflux disease (GERD) is the most common cause of noncardiac chest pain (NCCP). An empirical trial with a proton pump inhibitor (the PPI test) was introduced as a non-invasive, readily available alternative diagnostic tool for NCCP. So, PPI test is known to be the first diagnostic step for NCCP. In Korea, in contrast to Western countries, patients with NCCP but who are without alarming features have been recommended to undergo esophagogastroduodenoscopy (EGD) to exclude gastric cancer or peptic ulcers because of the higher prevalence of peptic ulcer disease and gastric cancers in the region. However, there are only a few small sized studies in Korea. The report of Pyo et al. showed that out of 349 NCCP patients, reflux esophagitis was diagnosed in 35 patients (10.0%), peptic ulcer in 48 patients (13.8%) and gastric cancer in 1 patient. This result suggests that in Korea, unlike the West, stomach/duodenal lesions other than GERD are common causes of NCCP. Therefore, in Korea, prior to PPI test or empirical therapy, performing EGD is necessary for evaluating NCCP to rule out gastroduodenal lesions. Furthermore, a large scaled prospective study is needed to assess the accurate relation of endoscopic findings and chest pain.

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