Abstract：
BACKGROUND: The Lyon consensus classifies the evidence of gastroesophageal reflux (GERD) based on endoscopic features and results of pH/impedance monitoring (pH-MII) including the post-reflux swallow-induced peristaltic wave index (PSPWI) and mean nocturnal baseline impedance (MNBI). The Wingate consensus established criteria to reduce inter-reviewer variability when assessing reflux episodes and PSPWI by impedance. This study aims to assess the influence of the Wingate criteria on the different pH-MII parameters obtained by automated analysis.
METHODS: Thirty consecutive pH-MII off PPI were reviewed according to Wingate criteria. Number of impedance episodes and PSPWI were compared before and after censoring from automatic analysis. Reflux categorization according to Lyon consensus between censored and uncensored data was compared. Pearson correlations between impedance parameters and censored episodes were calculated.
RESULTS: Censoring the tracings significantly reduced the number of reflux episodes (66 [42-90.25] vs. 44.5 [21.5-61.5], p = 0.0105). Reasons for censoring were as follows: 1/ anterograde episode: 9.5 [6-13], 2/ impedance drop <50%: 1 [0-3], 3/ duration <4 s: 1 [0-2], 4/ <2 distal channels: 2.5 [1-4], and 5/ artifacts: 2 [1-5]. Censored episodes were in majority non-acid (16.5 [13-26.5] vs. 2 [0-4], p < 0.00001). Censoring altered the categorization of impedance episodes (<40 episodes, 6 vs. 13 for resp. uncensored vs. censored tracings, 40-80 episodes: 13 vs. 13, and >80 episodes: 11 vs. 4, p = 0.0264), but not the symptom index, the symptom association probability, or the categorization according to the Lyon consensus. Nevertheless, individual tracings were affected. The percentage of censored episodes was inversely correlated with the number of acidic impedance episodes (r = -0.62, p = 0.0002).
CONCLUSIONS: Manual interpretation of impedance tracings based on the Wingate consensus reduces the number of impedance episodes, impacting on reflux categorization. Acidic reflux episodes are less likely to be censored, harboring a potential at improving automatic pH-MII analysis.
METHODS: Thirty consecutive pH-MII off PPI were reviewed according to Wingate criteria. Number of impedance episodes and PSPWI were compared before and after censoring from automatic analysis. Reflux categorization according to Lyon consensus between censored and uncensored data was compared. Pearson correlations between impedance parameters and censored episodes were calculated.
RESULTS: Censoring the tracings significantly reduced the number of reflux episodes (66 [42-90.25] vs. 44.5 [21.5-61.5], p = 0.0105). Reasons for censoring were as follows: 1/ anterograde episode: 9.5 [6-13], 2/ impedance drop <50%: 1 [0-3], 3/ duration <4 s: 1 [0-2], 4/ <2 distal channels: 2.5 [1-4], and 5/ artifacts: 2 [1-5]. Censored episodes were in majority non-acid (16.5 [13-26.5] vs. 2 [0-4], p < 0.00001). Censoring altered the categorization of impedance episodes (<40 episodes, 6 vs. 13 for resp. uncensored vs. censored tracings, 40-80 episodes: 13 vs. 13, and >80 episodes: 11 vs. 4, p = 0.0264), but not the symptom index, the symptom association probability, or the categorization according to the Lyon consensus. Nevertheless, individual tracings were affected. The percentage of censored episodes was inversely correlated with the number of acidic impedance episodes (r = -0.62, p = 0.0002).
CONCLUSIONS: Manual interpretation of impedance tracings based on the Wingate consensus reduces the number of impedance episodes, impacting on reflux categorization. Acidic reflux episodes are less likely to be censored, harboring a potential at improving automatic pH-MII analysis.
摘要：
背景：里昂共识根据内镜特征和pH/阻抗监测（pH-MII）的结果对胃食管反流（GERD）的证据进行分类，包括反流后吞咽诱导的蠕动波指数（PSPWI）和平均夜间基线阻抗（MNBI）。Wingate共识建立了标准，以减少通过阻抗评估反流发作和PSPWI时的审阅者之间的变异性。本研究旨在评估Wingate标准对通过自动分析获得的不同pH-MII参数的影响。
方法：根据Wingate标准对30个连续的PPIpH-MII进行了综述。比较了自动分析前后的阻抗发作次数和PSPWI。比较了根据里昂共识在审查数据和未经审查数据之间的回流分类。计算了阻抗参数与删失发作之间的Pearson相关性。
结果：检查示踪可显著减少反流发作次数（66[42–90.25]与44.5[21.5-61.5],p=0.0105)。审查的原因如下：1/顺行发作：9.5[6-13]，2/阻抗下降<50%:1[0-3],3/持续时间<4s：1[0-2]，4/<2个远端通道:2.5[1-4],和5/工件：2[1-5]。审查的发作大多数是非酸性的（16.5[13-26.5]vs.2[0-4],p<0.00001)。审查改变了阻抗发作的分类(<40发作，6vs.13代表RESP。未经审查的vs.审查的痕迹，40-80集：13vs.13，和>80集：11vs.4，p=0.0264），但不是症状指数，症状关联概率，或者根据里昂共识进行分类。然而，个别痕迹受到影响。删失事件的百分比与酸性阻抗事件的数量成反比（r=-0.62，p=0.0002）。
结论：基于Wingate共识的阻抗描迹的手动解释减少了阻抗发作的次数，对反流分类的影响。酸性反流发作不太可能被审查，具有改善自动pH-MII分析的潜力。
方法：根据Wingate标准对30个连续的PPIpH-MII进行了综述。比较了自动分析前后的阻抗发作次数和PSPWI。比较了根据里昂共识在审查数据和未经审查数据之间的回流分类。计算了阻抗参数与删失发作之间的Pearson相关性。
结果：检查示踪可显著减少反流发作次数（66[42–90.25]与44.5[21.5-61.5],p=0.0105)。审查的原因如下：1/顺行发作：9.5[6-13]，2/阻抗下降<50%:1[0-3],3/持续时间<4s：1[0-2]，4/<2个远端通道:2.5[1-4],和5/工件：2[1-5]。审查的发作大多数是非酸性的（16.5[13-26.5]vs.2[0-4],p<0.00001)。审查改变了阻抗发作的分类(<40发作，6vs.13代表RESP。未经审查的vs.审查的痕迹，40-80集：13vs.13，和>80集：11vs.4，p=0.0264），但不是症状指数，症状关联概率，或者根据里昂共识进行分类。然而，个别痕迹受到影响。删失事件的百分比与酸性阻抗事件的数量成反比（r=-0.62，p=0.0002）。
结论：基于Wingate共识的阻抗描迹的手动解释减少了阻抗发作的次数，对反流分类的影响。酸性反流发作不太可能被审查，具有改善自动pH-MII分析的潜力。
