How to Increase the Diagnostic Yield of Upper-GI Endoscopy in Patients with Non-cardiac Chest Pain

MOHAMMAD FARIVAR and JAMES KOLTON, DEPT of MEDICINE and DEPT of PATHOLOGY, NORWOOD HOSPITAL, NORWOOD, MA 

42 consecutive patients (16 male, 26 female) underwent upper GI endoscopy (EGD) for evaluation of non-cardiac chest pain (NCCP).  The larynx was observed for evidence of posterior laryngeal erythema and intra-arytenoid erythema and edema (mild reflux laryngitis [RL]).  Additionally, 4 pinch biopsies were taken 2-4cm from the gastroesophageal junction to look for evidence of microscopic chronic esophagitis.

Results:  In 42 patients with NCCP, EGD was positive (grades I-IV esophagitis) in 13 (31%) patients.  RL was found in 33 individuals (79%) and biopsies were positive in 30 patients (64%).  Furthermore, in 18 Patients with only NCCP, endoscopy was positive in 5 (28%), RL was found in 9 (50%) and biopsy was positive in 7 (39%). In 4 (22%), both RL and biopsies were negative, and in 6 patients both RL and biopsies were positive.

Conclusions:  Addition of laryngoscopy and/or distal esophageal biopsy to EGD increases the diagnostic yield when evaluating patients with NCCP.