背景:Johnson-DeMeester综合评分(DMS)是诊断胃食管反流病(GERD)的历史金标准。里昂共识概述了通过pH监测诊断GERD的标准,定义正常酸暴露时间(AET)<4%,病理>6%,诊断不确定度从4%到6%。我们旨在(i)计算由DMS重新分类为正常或病理性的单独AET定义的临界研究的比例,(ii)确定仰卧AET对重新分类的重要性,和(iii)提出了一种新的分类系统,使用考虑位置变化的综合得分。
方法:这种单中心,回顾性,观察性研究分析了在48小时pH监测(BravopH胶囊)中总AET为2%~6%的患者的数据.预选预测因子(仰卧和直立AET)被包括在模型中以创建综合评分(即,pHoenix分数)使用回归系数。该模型进行了内部验证,并对DMS进行辨别能力测试,并与总AET进行比较。
结果:我们确定了114名患者(80[70.2%]名女性;中位年龄,55年)。使用总AET,26(22.8%)被归类为正常,88(77.2%)被归类为临界;然而,使用DMS,45例(39.5%)为正常,69例(60.5%)为病理。新的pHoenix评分显示出强的辨别能力(AUC:0.957[95%CI0.917,0.998]),具有较高的灵敏度和特异性(较低的阈值,94.4%和79.2%;上限阈值,87和95.8%)。与单独的AET相比,pHoenix评分显着降低了不确定病例的比例(77.2%vs.13.2%,p<0.001)。
结论:总AET对鉴别病理性反流的敏感性较低,因为它不考虑仰卧反流和直立反流。pHoenix评分改善了正常和病理病例之间的区别,并减少了歧义,提供了一种诊断GERD的替代方法,该方法解决了单独使用总AET或DMS的局限性。
BACKGROUND: The Johnson-DeMeester composite score (DMS) is the historical gold standard for diagnosing gastroesophageal reflux disease (GERD). The Lyon Consensus outlines criteria for diagnosing GERD by pH monitoring, defining normal acid exposure time (AET) as < 4% and pathological as > 6%, presenting diagnostic uncertainty from 4 to 6%. We aimed to (i) calculate the proportion of borderline studies defined by total AET alone that are reclassified as normal or pathological by the DMS, (ii) determine the importance of supine AET for reclassification, and (iii) propose a new classification system using a composite score that considers positional changes.
METHODS: This single-center, retrospective, observational study analyzed data from patients with an overall total AET from 2 to 6% on 48-h pH monitoring (Bravo pH capsule). Preselected predictors (supine and upright AET) were included in a model to create a composite score (i.e., pHoenix score) using the regression coefficients. The model was internally validated, and discriminative ability was tested against the DMS and compared to the total AET.
RESULTS: We identified 114 patients (80 [70.2%] women; median age, 55 years). Using the total AET, 26 (22.8%) were classified as normal and 88 (77.2%) as borderline; however, using the DMS, 45 (39.5%) were classified as normal and 69 (60.5%) as pathological. The new pHoenix score demonstrated strong discriminative ability (AUC: 0.957 [95% CI 0.917, 0.998]) with high sensitivity and specificity (lower threshold, 94.4% and 79.2%; upper threshold, 87 and 95.8%). Compared to the total AET alone, the pHoenix score significantly decreased the proportion of inconclusive cases (77.2% vs. 13.2%, p < 0.001).
CONCLUSIONS: Total AET has low sensitivity to identify pathological reflux as it disregards supine versus upright reflux. The pHoenix score improves the distinction between normal and pathological cases and reduces ambiguity, offering an alternative approach to diagnosing GERD that addresses the limitations of using total AET alone or the DMS.