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Segmental changes in smooth muscle contraction as a predictive factor of the response to high-dose proton pump inhibitor treatment in patients with functional chest pain

Authors
 Hyuk Lee  ;  Jun Chul Park  ;  Sung Kwan Shin  ;  Sang Kil Lee  ;  Yong Chan Lee 
Citation
 Journal of Gastroenterology and Hepatology, Vol.27(7) : 1192-1199, 2012 
Journal Title
 Journal of Gastroenterology and Hepatology 
ISSN
 0815-9319 
Issue Date
2012
MeSH
2-Pyridinylmethylsulfinylbenzimidazoles/administration & dosage ; 2-Pyridinylmethylsulfinylbenzimidazoles/pharmacology ; 2-Pyridinylmethylsulfinylbenzimidazoles/therapeutic use ; Adult ; Chest Pain/drug therapy* ; Chest Pain/etiology ; Chest Pain/physiopathology ; Drug Administration Schedule ; Esophageal pH Monitoring ; Esophagus/drug effects* ; Esophagus/physiopathology ; Female ; Humans ; Male ; Manometry/methods ; Middle Aged ; Muscle Contraction/drug effects* ; Muscle, Smooth/drug effects* ; Muscle, Smooth/physiopathology ; Prognosis ; Proton Pump Inhibitors/administration & dosage ; Proton Pump Inhibitors/pharmacology* ; Proton Pump Inhibitors/therapeutic use ; Rabeprazole ; Severity of Illness Index ; Treatment Outcome
Keywords
esophageal hypersensitivity ; functional chest pain ; high resolution manometry ; non-cardiac chest pain ; proton pump inhibitor
Abstract
BACKGROUND AND AIMS: High-dose proton pump inhibitor (PPI) treatment leads to relatively little symptomatic improvement in patients with functional chest pain (FCP). This study was to evaluate the use of smooth muscle segmental changes in esophageal contraction as measured by topographical plots of high resolution manometry (HRM) as predictive factors of the response to high-dose PPI treatment in FCP patients. METHODS: Thirty patients diagnosed with FCP were treated with rabeprazole 20 mg twice daily for 2 weeks and classified as positive and negative responders based on symptom intensity score. HRM topographical plots were analyzed for segment lengths, maximal wave amplitudes, and pressure volumes of the proximal and distal smooth muscle segments. RESULTS: A positive response was observed in 23.3% of the patients. While the pressure volume of the proximal segment was significantly higher in the positive responders than the negative responders (900.4 ± 91.5 mm Hg/cm per s vs. 780.5 ± 133.3 mm Hg/cm per s, P = 0.017), the pressure volume of the distal segment was significantly lower in the positive responders (1914.0 ± 159.8 mm Hg/cm per s vs. 2140.5 ± 276.2 mm Hg/cm per s, P = 0.014). A prominent shifting in pressure volume to the distal segment was observed in the negative responders compared with the positive responders (segmental ratio of pressure volume (SRPV): 2.9 ± 0.5 vs. 2.1 ± 0.1, P < 0.001), and 2.39 was found to be the SRPV that best differentiated positive and negative responders. CONCLUSIONS: A low SRPV was associated with a positive response to high-dose PPI treatment in patients with FCP.
Full Text
http://onlinelibrary.wiley.com/doi/10.1111/j.1440-1746.2012.07110.x/abstract
DOI
22413883
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Park, Jun Chul(박준철) ORCID logo https://orcid.org/0000-0001-8018-0010
Shin, Sung Kwan(신성관) ORCID logo https://orcid.org/0000-0001-5466-1400
Lee, Sang Kil(이상길) ORCID logo https://orcid.org/0000-0002-0721-0364
Lee, Yong Chan(이용찬) ORCID logo https://orcid.org/0000-0001-8800-6906
Lee, Hyuk(이혁)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/90815
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