Chest pain: non-cardiac: omeprazole reduces pain.

Clinical bottom line (level 1b)

  1. Patients with non-cardiac chest pain due to gastroesophageal reflux have reduced pain (NNT = 3 at 8 weeks) and fewer painful days when they take omeprazole (29 days fewer).
  2. There is no clear difference in side effects.
Achem et al: Digestive Diseases and Sciences 1997; 42 (10): 2138-2145
Expires Unknown Month 2001

The study

Double-blinded concealed randomised trial without intention-to-treat
Setting: gastroenterology division, university hospital, USA

36 patients (aged mean 49 years, 64% female)
  • dominant complaint of retrosternal chest pain and suggestive of coronary artery disease (squeezing, oppressive and related to effort and/or emotion) lasting 6 months or more, occurring 3 or more times a week
  • other causes excluded (normal ECG and angiography/ stress thallium test)
  • gastroesophageal reflux documented by 24 hr pH monitoring

Control Group: (n = 19, 18 analysed): placebo
Experimental Group: (n = 17, 16 analysed): omeprazole 20 mg po twice daily
All patients received antacid tablets (Maalox) to take as required for chest pain, and were advised on dietary restrictions, elevation of the head of the bed, avoiding tight garments and waiting at least 3 hours before reclining after a meal.
94% followed for 8 weeks

The evidence

Outcome Time to outcome CEREERRRR
(95% CI)		ARR
(95% CI)		NNT
(95% CI)
chest pain not better 8 weeks 17
(94.4%)		 3
(18.9%)		 80%
(45% to 93%)		 75.7%
(53.8% to 97.6%)		 1
(1 to 2)
adverse effects 8 weeks 9
(50.0%)		 7
(43.8%)		 13%
(-80% to 58%)		 6.25%
(-27.3% to 39.8%)		 16
(NNT = 3 to infinity;
NNH = 4 to infinity)
no reduction in number of chest pain days 8 weeks 10
(55.6%)		 3
(18.8%)		 66%
(-1% to 89%)		 36.8%
(6.93% to 66.7%)		 3
(1 to 14)

Outcome Control Group
(SD)		 Experimental Group
(SD)		 Mean Difference
(95% CI)
pain-free days (%) 39.0
(7.2) 		10.0
(6.9) 		29
(24 to 34)

  • A significant placebo effect was noted.

    • Citation

    1. Achem SR, Kolts BE, MacMath T, et al: effects of omeprazole versus placebo in treatment of noncardiac chest pain and gastroesophageal reflux. Digestive Diseases and Sciences 1997; 42 (10): 2138-2145
    Search Terms: chest pain in Cochrane
    Contributor: Chris Ball and Clare Wotton, Unknown Month 2000
    Reviewer:

    Clinical Question.
    Patient non-cardiac chest pain
    Intervention or Exposure omeprazole
    Comparison placebo
    Outcome reduced pain, side effects