4. Appropriateness of Gastroscopy: Atypical Chest Pain [1]

Introduction

Atypical chest pain (ACP) can be defined as “chest pain in patients with no objective evidence of coronary heart disease” [1]. In the USA, about 30 % of the 600 000 patients who undergo coronary angiography every year for presumed cardiac pain are found to have no abnormality of the coronary arteries and are referred to a gastroenterologist for esophageal evaluation [2]. 90 000 - 200 000 new cases of ACP are diagnosed every year in the USA [2] [3] [4] .

In November 1998, a multidisciplinary European expert panel convened in Lausanne, Switzerland, to discuss and develop criteria for the appropriate use of gastrointestinal endoscopy, a widely-used procedure, regarded as highly accurate and safe. The RAND appropriateness method was chosen for this purpose, because it allows the development of appropriateness criteria based on published evidence and supplemented by explicit expert opinion. A detailed description of the RAND appropriateness method, including the literature search process [5], and of the whole process, as well as the global results of the panel [6], are published as separate articles in this issue of the Journal. The literature review was based on a systematic search of Medline, Embase and the Cochrane Library conducted up to the end of 1997 and completed with some key articles published in 1998. Updating and revision of the literature review is currently ongoing.

This article presents 1. the literature review on this question that was provided to panelists for study and comment prior to the panel to support their ratings of appropriateness of upper gastrointestinal endoscopy in the diagnosis and handling of atypical chest pain; 2. an overview of the main panel results on that question; 3. a summary of the published evidence and of the panel based appropriateness criteria.

Gastroesophageal reflux disease (GERD) and Barrett's esophagus as identified sources of chest pain are covered in companion articles [7] [8] .

1 The European Panel on Appropriateness of Gastrointestinal Endoscopy (EPAGE, Lausanne, Switzerland)

References

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1 The European Panel on Appropriateness of Gastrointestinal Endoscopy (EPAGE, Lausanne, Switzerland)