To investigate the diagnostic value of 24-hour esophageal pH-impedance monitoring combined with serum gastrin, pepsinogenⅠ(PGⅠ), and pepsinogenⅡ(PGⅡ) for gastroesophageal reflux-related chest pain.

A retrospective analysis was conducted on 158 patients with suspected gastroesophageal reflux-related chest pain who were admitted to Tongliao People's Hospital from December 2023 to October 2025. They were divided into two groups based on the presence of gastroesophageal reflux: the gastroesophageal reflux group and the non-reflux group (patients with related chest pain but without gastroesophageal reflux). The general data, 24-hour esophageal pH-impedance monitoring results, and serum gastrin, PGⅠ, and PGⅡ levels between patients with gastroesophageal reflux and those without reflux were compared. Multivariate logistic regression analysis was conducted to identify the influencing factors for the occurrence of gastroesophageal reflux-related chest pain. ROC curve analysis was conducted to evaluate the value of 24-hour esophageal pH-impedance monitoring alone, as well as its combination with serum gastrin, PGⅠ, and PGⅡ in diagnosing gastroesophageal reflux-related chest pain. Internal validation was performed using Bootstrap sampling with 100 iterations of cross-validation. The Hosmer-Lemeshow test was used to evaluate the goodness-of-fit of the diagnostic model combining 24-hour esophageal pH-impedance monitoring with serum gastrin, PGⅠ, and PGⅡ levels for diagnosing gastroesophageal reflux-related chest pain.

Among 158 patients with suspected gastroesophageal reflux-related chest pain, 80 were diagnosed with the condition. Patients in the gastroesophageal reflux group exhibited higher rates of acid reflux episodes, longer mean acid clearance times, and more frequent gas reflux episodes compared to patients in the non-reflux group (P<0.05). The levels of gastrin and PGⅡ in the gastroesophageal reflux group were lower than those in the non-reflux group, while the level of PGⅠ was higher than that in the non-reflux group (P<0.05). The number of acid reflux episodes, mean acid clearance time, number of gas reflux episodes, and serum gastrin, PGⅠ, and PGⅡ levels were factors influencing the occurrence of gastroesophageal reflux-related chest pain (P<0.05). The value of 24-hour esophageal pH-impedance monitoring combined with serum gastrin, PGⅠ, and PGⅡ levels demonstrated superior diagnostic value for gastroesophageal reflux-related chest pain compared to standalone diagnosis (P<0.05). Internal validation results from Bootstrap resampling indicated that the calibration curve was essentially consistent with the ideal curve. The Hosmer-Lemeshow test indicated that the diagnostic model exhibited good goodness-of-fit.

The levels of serum gastrin and PGⅡ in patients with gastroesophageal reflux-related chest pain decrease, while the level of PGⅠ increases. The 24-hour esophageal pH-impedance monitoring combined with serum gastrin, PGⅠ, and PGⅡ levels has a relatively high value in the diagnosis of gastroesophageal reflux-related chest pain.