Abstract
Twenty-four normal subjects and 64 symptomatic patients with various degrees of reflux disease (24 with reflux symptoms without esophagitis and 21 with mild and 19 with severe esophagitis) underwent quantitative 24-hr intraesophageal pH monitoring. Various reflux parameters during supine, interprandial, and postprandial periods were examined by binary logistic regression and by CART analysis to determine the sensitivity and specificity to separate the various groups of subjects and patients. The distinction was excellent between asymptomatic controls and patients with severe erosive esophagitis (sensitivity and specificity both 100% by logistic regression and 95% and 88%, respectively, by CART), but discrimination was poor when asymptomatic controls were compared to symptomatic patients without esophagitis (71% and 79% by logistic regression and 75% and 92% by CART), which is the most important indication for pH recording in clinical practice. A 3-hr postprandial pH recording was inadequate to distinguish the various groups. The acidity of the reflux episodes during the night appeared to be a crucial factor in the development of severe erosive esophagitis. The duration of esophageal acid exposure was another important factor in the development of reflux lesions.
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References
Howard PJ, Maher L, Pryde A, Heading RC: Symptomatic gastro-oesophageal reflux, abnormal oesophageal acid exposure, and mucosal acid sensitivity are three separate, though related, aspects of gastro-oesophageal reflux disease. Gut 32:128–132, 1991
Wiener GJ, Richter JE, Cooper JB, Wu WC, Castell DO: The symptom index: A clinical important parameter of ambulatory 24 hour oesophageal pH monitoring. Am J Gastroenterol 83:358–361, 1988
Janssens J, Vantrappen G, Ghillebert G: 24-hour recording of esophageal pressure and pH in patients with noncardiac chest pain. Gastroenterology 90:1978–1984, 1986
De Caestecker JS, Blackwell JN, Preyde A, Heading RC: Daytime gastro-esophageal reflux is important in oesophagitis. Gut 28:519–526, 1987
Rokkas T, Angionnsah A, Uzoechina E, Owen WJ, Sladen GE: The role of shorter than 24-h pH monitoring periods in the diagnosis of gastro-esophageal reflux. Scand J Gastroenterol 21:614, 1986
Braman L, Friedman J, Alesken R, Stone C: Classification and Regression Trees. Wadsworth, 1984
Richter JE, Castell DA: Gastroesophageal reflux. Pathogenesis, diagnosis and therapy. Ann Intern Med 97:93–103, 1982
Rosen SN, Pope II CE: Extended esophageal pH-monitoring: An analysis of the literature and assessment of its role in the diagnosis and management of gastroesophageal reflux. J Clin Gastroenterol 11:260–270, 1989
Johnson LF, Demeester TR: Twenty-four-hour pH monitoring of the distal esophagus. Am J Gastroenterol 62:325–332, 1974
Demeester TR, Ching-I Wang, Wernly JA, Pellegrini CA, Little AG, Klementschitsch P, Bermudez G, Johnson LF, Skinner DB: Technique, indication, and clinical use of 24 hour esophageal pH monitoring. J Thorac Cardiovasc Surg 79:656–670, 1980
Euler AR, Byrne WJ: Twenty-four-hour esophageal intraluminal pH probe testing: A comparative analysis. Gastroenterology 80(5):957–961, 1981
Johnsson F, Joelsson B, Isberg PE: Ambulatory 24 hour intraesophageal pH-monitoring in the diagnosis of gastroesophageal reflux disease. Gut 28:1145–1150, 1987
Galmiche JP, Guillard JF, Denis P, Boussakr K, Lefrançois R, Colin R: Etude du pH esophagien en période postprandiale chez le sujet normal et au cours du syndrôme de reflux gastrooesophagien. Intérêt diagnostique d'un score de reflux acide. Gastroenterol Clin Biol 4:531–539, 1980
Stanciu C, Hoare RC, Bennett JR: Correlation between manometric and pH tests for gastro-oesophageal reflux. Gut 18:536–540, 1977
Klauser AG, Heinrich C, Schindlbeck NE, Müller-Lissner SA: Is long-term esophageal pH monitoring of clinical value? Am J Gastroenterol 84(4):362–366, 1989
Schlesinger PK, Donahue PE, Schmid B, Layden TJ: Limitations of 24 hour intraesophageal pH monitoring in the hospital setting. Gastroenterology 89:797–804, 1985
Mattioli S, Pilotti U, Spangaro M, Grigioni WF, Zannoli R, Felice U, Conci A, Gozzetti G: Reliability of 24-hour home esophageal pH-monitoring in diagnosis of gastroesophageal reflux. Dig Dis Sci 34:71–78, 1989
Pujol A, Grande L, Ros E, Pera C: Utility of in patient 24 hour intraesophageal pH monitoring in diagnosis of gastroesophageal reflux. Dig Dis Sci 33(9):1134–1140, 1988
Schindlbeck NE, Heinrich C, König A, Dendorfer A, Pace F, Müller-Lissner SA: Optimal thresholds, sensitivity, and specificity of long-term pH-metry for the detection of gastroesophageal reflux disease. Gastroenterology 93:85–90, 1987
Atkinson M, Van Gelder Z: Esophageal pH recording in the assessment of gastroesophageal reflux and its consequences. Dig Dis Sci 22(4):365–370, 1977
Branicki FJ, Evans DF, Ogilva AL, Atkinson M, Hardcastle JD: Ambulatory monitoring of oesophageal pH in reflux oesophagitis using a portable radiotelemetry system. Gut 23:992–998, 1982
Fink SM, McCallum RW: The role of prolonged esophageal pH monitoring in the diagnosis of gastroesophageal reflux. JAMA 252:1160–1164, 1984
Klauser AG, Schindlbeck NE, Müller-Lissner SA: Symptoms in gastroesophageal reflux disease. Lancet 335:205–208, 1990
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Ghillebert, G., Demeyere, A.M., Janssens, J. et al. How well can quantitative 24-hour intraesophageal pH monitoring distinguish various degrees of reflux disease?. Digest Dis Sci 40, 1317–1324 (1995). https://doi.org/10.1007/BF02065545
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DOI: https://doi.org/10.1007/BF02065545