TITLE

Area Under pH 4: A More Sensitive Parameter for the Quantitative Analysis of Esophageal Acid Exposure in Adults

AUTHOR(S)
Dinelli, Marco; Passaretti, Sandro; Di Francia, Italo; Fossati, Daniela; Tittobello, Alberto
PUB. DATE
November 1999
SOURCE
American Journal of Gastroenterology;Nov1999, Vol. 94 Issue 11, p3139
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
OBJECTIVE: Traditional quantitative analysis of 24-h esophageal pH monitoring data does not include the pH of reflux episodes. Area under pH 4 (AU4) is a recently introduced parameter that describes the acid exposure rate through both duration and depth of pH falls. METHODS: In Study A, we enrolled 20 healthy controls and 42 patients (18 without esophagitis, 24 with Savary I-III esophagitis) in a study evaluating reference values for 24-h reflux time at pH <4 (RT) and 24-h AU4 by means of receiver operating characteristic (ROC) discriminant analysis. For Study B, we next prospectively applied the resulting cutoffs to 16 healthy controls and to 110 gastroesophageal reflux (GERD) patients (55 with esophagitis) to adjust sensitivity, specificity, and predictive values of both RT and AU4. RESULTS: In Study A, the best cutoff values were 5.1% for RT (Area Index ± SE, 0.899 ± 0.038; 95% confidence interval [C.I.], 0.796 ± 0.961) and 36.1 pH X min for AU4 (Area Index ± SE, 0.935 ± 0.03; 95% CL, 0.842 ± 0.981); AU4 gave the best performance (p = 0.038 vs RT) in discriminating controls and GERD patients. In Study B, RT was abnormal in three controls and 79 patients; AU4 identified all the controls and patients with abnormal RT and also 10/31 patients (32.3%) with so-called "normal" acid exposure (according to RT). In the whole GERD group of patients, AU4 and RT specificity was 81.2%, whereas sensitivity was 71.8% for RT and 80.9% for AU4 (χ², 61.831; DF, 1; p< 0.005); PPV/NPV were 96.3%/29.5% for RT, and 96.7%/38.2% for AU4. CONCLUSIONS: AU4 appears to be a simple and sensitive quantitative parameter to measure the esophageal acid exposure in adults submitted to 24-h pH monitoring, and it could be an useful clinical aid in evaluating normal RT tests where, from a clinical point of view, a reflux disease is highly likely.
ACCESSION #
17632984

 

Related Articles

  • Assessment of reflux symptom severity: methodological options and their attributes. Bytzer, P. // Gut;May2004 Supplement 4, Vol. 53, piv28 

    Despite major advances in our understanding of reflux disease, the management of this disorder still presents many challenges. Reduction of heartburn is the most readily apparent objective for the patient with reflux disease. Thus the ability to measure heartburn accurately is of fundamental...

  • Physical and pH Properties of Gastroesophagopharyngeal Refluxate: A 24-hour Simultaneous Ambulatory Impedance and pH Monitoring Study. Kawamura, Osamu; Aslam, Muhammad; Rittmann, Tanya; Hofmann, Candy; Shaker, Reza // American Journal of Gastroenterology;Jun2004, Vol. 99 Issue 6, p1000 

    OBJECTIVES: Frequency occurrence of nonacidic and nonliquid reflux events in the pharynx has not been systematically studied. The aim of the present study was to characterize the physical (liquid, gas, and mixed gas/liquid) and pH properties of the gastroesophagopharyngeal refluxate.METHODS: We...

  • Heartburn Correlated to 24--Hour pH Monitoring and Radiographic Examination of the Esophagus. Ott, David J.; McManus, Christopher M.; Ledbetter, M. Stephen; Chen, Michael Y. M.; Gelfand, David W. // American Journal of Gastroenterology;Oct1997, Vol. 92 Issue 10, p1827 

    Objectives: Study relationship of gastroesophageal reflux disease to findings on radiographic examination of the esophagus. Methods: We correlated heartburn (HB) in 360 patients (174 women; 186 men; mean age, 53 yr) to results of pH monitoring (pHM) and radiographic examination of the esophagus....

  • Is Carditis the Earliest Manifestation of Gastroesophageal Reflux Disease? Brand, R. E.; Thompson, Jon S. // American Journal of Gastroenterology;Mar1998, Vol. 93 Issue 3, p304 

    Discusses research on gastroesophageal reflux disease (GERD). Reference to a study by S. Oberg et al., published in a 1997 issue of the journal "Annals of Surgery"; Possible manifestation of GERD through the finding of cardiac mucosa at the gastroesophageal junction; Study procedure.

  • The Influence of Rapid Food Intake on Postprandial Reflux: Studies in Healthy Volunteers. Wildi, Stephan M.; Tutuian, Radu; Castell, Donald O. // American Journal of Gastroenterology;Sep2004, Vol. 99 Issue 9, p1645 

    BACKGROUND: The postprandial increase of gastroesophageal reflux (GER) results largely from an increase in the rate of transient lower esophageal sphincter relaxations (TLESRs). Gastric distension is believed to be the most important contributing factor. The aim of this study was to determine...

  • Esomeprazole did not improve asthma symptoms in poorly controlled asthma. Ram, Felix S. F.; Wise, R. // ACP Journal Club;8/18/2009, Vol. 151 Issue 2, p8 

    The article reports that esomeprazole did not improve asthma symptoms in patients with poorly controlled asthma and asymptomatic gastroesophageal reflux. A study conducted in 19 clinical centers in the U.S. has conclusively shown that these widely prescribed medications for patients with poorly...

  • Impact of Gastroesophageal Reflux on Survival in the Community. Talley, Nicholas J.; Richard Locke, III, G.; McNally, M.; Schleck, Cathy D.; Zinsmeister, Alan R.; Joseph Melton, III, L. // American Journal of Gastroenterology;Jan2008, Vol. 103 Issue 1, p12 

    BACKGROUND: Concerns have been raised regarding the risks associated with gastroesophageal reflux (GER). We examined the association of gastroesophageal reflux with survival. METHODS: Between 1988 and 1993, valid symptom surveys were mailed to population-based cohorts. Respondents were...

  • Budesonide.  // Reactions Weekly;6/4/2005, Issue 1054, p6 

    Discusses research being done on esophagitis in an adolescent patient with Crohn's disease after changing treatment from prednisolone to budesonide. Reference to a study by K. Weigand et al published in the October 2004 issue of "Zeitschrift fur Gastroenterologie"; Findings of the study.

  • Preservation of Gastric Acid Secretion May Be Important for the Development of Gastroesophageal Junction Adenocarcinoma in Japanese People, Irrespective of the H. pylori Infection Status. Inomata, Yoshifumi; Koike, Tomoyuki; Ohara, Shuichi; Abe, Yasuhiko; Sekine, Hitoshi; Iijima, Katsunori; Ariizumi, Ken; Yamagishi, Hatsushi; Kitagawa, Yasushi; Imatani, Akira; Shimosegawa, Tooru // American Journal of Gastroenterology;May2006, Vol. 101 Issue 5, p926 

    BACKGROUND: We have previously reported that Helicobacter pylori infection prevents reflux esophagitis (RE) and Barrett's esophagus (BE) by decreasing gastric acid secretion. Gastroesophageal (GE) junction adenocarcinoma, including Barrett's adenocarcinoma, has been thought to be a complication...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics