- Title
- Acid-suppressive therapy with esomeprazole for relief of unexplained chest pain in primary care: a randomized, double-blind, placebo-controlled trial
- Creator
- Flook, Nigel W.; Moayyedi, Paul; Dent, John; Talley, Nicholas J.; Persson, Tore; Karlson, Björn W.; Ruth, Magnus
- Relation
- American Journal of Gastroenterology Vol. 108, Issue 1, p. 56-64
- Publisher Link
- http://dx.doi.org/10.1038/ajg.2012.369
- Publisher
- Nature Publishing Group
- Resource Type
- journal article
- Date
- 2013
- Description
- Objectives: High-quality data regarding the efficacy of acid-suppressive treatment for unexplained chest pain are lacking. The aim of this study was to evaluate the efficacy of esomeprazole in primary-care treatment of patients with unexplained chest pain stratified for frequency of reflux/regurgitation symptoms. Methods: Patients with a ≥2-week history of unexplained chest pain (unrelated to gastroesophageal reflux) who had at least moderate pain on ≥2 of the last 7 days were stratified by heartburn/regurgitation frequency (≤1 day/week (stratum 1) vs. ≥2 days/week (stratum 2)) and randomized to 4 weeks of double-blind treatment with twice-daily esomeprazole 40 mg or placebo. Chest pain relief during the last 7 days of treatment (≤1 day with minimal symptoms assessed daily using a 7-point scale) was analyzed by stratum in keeping with the predetermined analysis plan. Results: Overall, 599 patients (esomeprazole: 297, placebo: 302) were randomized. In stratum 1, more esomeprazole than placebo recipients achieved chest pain relief (38.7% vs. 25.5%; P=0.018); no between-treatment difference was observed in stratum 2 (27.2% vs. 24.2%; P=0.54). However, esomeprazole was superior to placebo in a post-hoc analysis of the whole study population (combined strata; 33.1% vs. 24.9%; P=0.035). Conclusions: A 4-week course of high-dose esomeprazole provided statistically significant relief of unexplained chest pain in primary-care patients who experienced infrequent or no heartburn/regurgitation, but there was no such significant reduction in patients with more frequent reflux symptoms.
- Subject
- acid-suppressive therapy; esomeprazole; unexplained chest pain; primary care; randomised double-blind placebo-controlled trial
- Identifier
- http://hdl.handle.net/1959.13/1299848
- Identifier
- uon:19963
- Identifier
- ISSN:0002-9270
- Language
- eng
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