Short course of @entity4546 : a better first diagnostic approach to noncardiac XXXX than endoscopy, manometry, or 24-hour esophageal pH monitoring.

@entity662 @entity1 @entity2910 @entity354 @entity4546
Noncardiac @entity662 (NCCP) presents as a frequent diagnostic challenge, with @entity1 tending to use a disproportionate level of health care resources. @entity354 ( @entity354 ) is the most frequent cause of NCCP. GOALS: To test the efficacy of a potent acid-suppressing agent as a diagnostic test in the evaluation of NCCP and to compare it with three commonly used tests. STUDY: Eighteen @entity1 and 24 @entity1 , aged 22 to 77 years, who presented with recurrent @entity662 complaints of a noncardiac etiology, as determined by rest/stress perfusion imaging with technetium Tc99m sestamibi (MIBI), were enrolled in a prospective, double-blinded, placebo-controlled, crossover trial using high-dose @entity4546 . Thirty-seven @entity1 completed both arms of the trial. Findings were compared with those of endoscopy, manometry, and ambulatory 24-hour two-channel esophageal pH monitoring. All @entity1 underwent initial diagnostic upper endoscopy, esophageal manometry, and 24-hour pH monitoring. @entity1 were then randomly assigned to either placebo or @entity4546 (40 mg/d orally twice daily) for 14 days, washed out for 21 days, and then crossed over. @entity1 's symptoms were determined using a Visual Analogue Scale to measure the severity of @entity662 before and after each period. RESULTS: Seventy-one percent of @entity1 in the @entity4546 arm reported improved @entity662 , whereas only 18% in the placebo arm did. Abnormal results on manometry (20%), 24-hour pH monitoring (42%), or endoscopy with visual evidence of @entity2910 (26%) were found less frequently. Combination of the three tests did not significantly increase their usefulness. In NCCP @entity1 with @entity354 , as defined by positive results on a 24-hour pH test or presence of @entity2910 on endoscopy, @entity4546 treatment led to a response in 95% of @entity1 , whereas 90% of @entity354 -positive @entity1 treated with placebo did not respond. Of NCCP @entity1 determined to be @entity354 negative, 39% responded to @entity4546 . CONCLUSIONS: @entity4546 as a first diagnostic tool in the evaluation of MIBI-negative NCCP is sensitive and specific for determining the cause of NCCP. Endoscopy, manometry, and 24-hour pH monitoring were not only less sensitive in diagnosing NCCP, but they were significantly more expensive.
