Читать книгу The Esophagus - Группа авторов - Страница 38

Gastroesophageal reflux disease is the GI etiology in the majority of NCCP/ECP cases. We recommend that all patients with suspected ECP be evaluated for GERD, initially by empiric treatment with a two‐ to four‐week trial with PPIs (bid dosing if daily not responsive) and if not responsive by directed testing. The duration of trial treatment should be in view of the frequency of CP symptoms to ensure that the duration of intervention with PPI therapy appropriately captures the time windows for reported symptoms. If patients positively respond to the PPI, they should be continued on the PPI at the lowest dose necessary for symptom control. Patients who do not respond to PPI should undergo further investigation to evaluate any reflux with pH‐impedance monitoring. Our practice recommendation is to do on bid PPI (ensuring also good compliance with the timing of PPI ingestion – 30–60 min before breakfast and dinner). If pH‐impedance monitoring is negative, these patients should be evaluated for other causes of esophageal chest pain, as outlined in Figure 2.1.