PMID- 21782769
OWN - NLM
STAT- MEDLINE
DCOM- 20120123
LR  - 20220330
IS  - 1542-7714 (Electronic)
IS  - 1542-3565 (Linking)
VI  - 9
IP  - 10
DP  - 2011 Oct
TI  - Caution about overinterpretation of symptom indexes in reflux monitoring for 
      refractory gastroesophageal reflux disease.
PG  - 868-74
LID - 10.1016/j.cgh.2011.07.009 [doi]
AB  - BACKGROUND & AIMS: Symptom index (SI) and symptom association probability (SAP) 
      are indexes used to analyze data collected from ambulatory pH and/or impedance 
      monitoring and quantify the association between symptoms and reflux events. 
      However, their characteristics are not well defined. We measured factors that 
      affect SI and SAP values to determine their utility in assessing patients with 
      refractory gastroesophageal reflux disease (GERD). METHODS: We conducted a 
      cross-sectional study of 254 patients with poor responses to proton pump 
      inhibitor (PPI) therapy. Participants underwent esophagogastroduodenoscopy and 
      wireless pH (n = 127) or impedance/pH monitoring when they were not receiving PPI 
      therapy (n = 41) or impedance/pH monitoring while they received twice-daily PPI 
      therapy (n = 86). SI and SAP values were calculated individually; ranges of 
      values for each cell in the 2 x 2 contingency table were determined. Monte Carlo 
      simulation was conducted to determine how varying reflux and symptom rates within 
      the contingency table impacted the expected value and variability in SI and SAP. 
      RESULTS: At best, only 33% of patients who were refractory to PPI therapy had 
      positive SI or SAP scores for acid or nonacid reflux events. Abnormal SAP (>95%) 
      and SI (>50%) scores required high rates of reflux. At reflux rates less than 
      10%, observed in 70% of the studied population, SI and SAP values were largely 
      determined by chance occurrences, rather than the relationship between symptoms 
      and reflux. The values for each index varied significantly day-to-day. 
      CONCLUSIONS: SI or SAP indexes can be overinterpreted, unless patients with 
      gastroesophageal reflux disease who are refractory to PPI therapy have high rates 
      of reflux.
CI  - Copyright (c) 2011 AGA Institute. Published by Elsevier Inc. All rights reserved.
FAU - Slaughter, James C
AU  - Slaughter JC
AD  - Department of Biostatistics, Vanderbilt University Medical Center, Nashville, 
      Tennessee, USA.
FAU - Goutte, Marion
AU  - Goutte M
FAU - Rymer, Jennifer A
AU  - Rymer JA
FAU - Oranu, Amanke C
AU  - Oranu AC
FAU - Schneider, Jonathan A
AU  - Schneider JA
FAU - Garrett, C Gaelyn
AU  - Garrett CG
FAU - Hagaman, David
AU  - Hagaman D
FAU - Vaezi, Michael F
AU  - Vaezi MF
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20110723
PL  - United States
TA  - Clin Gastroenterol Hepatol
JT  - Clinical gastroenterology and hepatology : the official clinical practice journal 
      of the American Gastroenterological Association
JID - 101160775
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
CIN - Clin Gastroenterol Hepatol. 2011 Oct;9(10):816-7. PMID: 21791195
MH  - Adult
MH  - Aged
MH  - Cross-Sectional Studies
MH  - Drug Monitoring/*methods
MH  - Electric Impedance
MH  - Female
MH  - Gastric Juice/*chemistry
MH  - Gastroesophageal Reflux/*diagnosis/drug therapy
MH  - Humans
MH  - Hydrogen-Ion Concentration
MH  - Male
MH  - Middle Aged
MH  - Proton Pump Inhibitors/administration & dosage
MH  - *Severity of Illness Index
EDAT- 2011/07/26 06:00
MHDA- 2012/01/24 06:00
CRDT- 2011/07/26 06:00
PHST- 2011/03/02 00:00 [received]
PHST- 2011/06/30 00:00 [revised]
PHST- 2011/07/11 00:00 [accepted]
PHST- 2011/07/26 06:00 [entrez]
PHST- 2011/07/26 06:00 [pubmed]
PHST- 2012/01/24 06:00 [medline]
AID - S1542-3565(11)00737-3 [pii]
AID - 10.1016/j.cgh.2011.07.009 [doi]
PST - ppublish
SO  - Clin Gastroenterol Hepatol. 2011 Oct;9(10):868-74. doi: 
      10.1016/j.cgh.2011.07.009. Epub 2011 Jul 23.