Validation of the Lyon classification for GORD diagnosis: acid exposure time assessed by prolonged wireless pH monitoring in healthy controls and patients with erosive oesophagitis
| Autor: | Fiona Warburton, Terry Wong, Sebastian Zeki, Radu-Ionut Rusu, Emily Tucker, Jafar Jafari, Mark A. Fox, Jason M. Dunn |
|---|---|
| Přispěvatelé: | University of Zurich, Wong, Terry |
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Adult
Male medicine.medical_specialty Esophageal pH Monitoring Adolescent 610 Medicine & health Ph monitoring 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans 2715 Gastroenterology Erosive oesophagitis Esophagitis Peptic Aged Aged 80 and over business.industry Gastroenterology Middle Aged 10219 Clinic for Gastroenterology and Hepatology 030220 oncology & carcinogenesis Case-Control Studies Gastroesophageal Reflux 030211 gastroenterology & hepatology Female business |
| DOI: | 10.5167/uzh-209658 |
| Popis: | ObjectiveAcid exposure time (AET) from ambulatory pH studies and reflux oesophagitis are independent measurements used by the Lyon classification to diagnose GORD. This study aimed to validate AET reference ranges and diagnostic thresholds by analysis of 96-hour wireless pH studies from healthy, asymptomatic controls (HCs) and patients with and without oesophagitis.DesignHC and consecutive patients referred for wireless pH studies (off acid suppressants for >7 days) underwent 96-hour pH studies at two tertiary referral centres. Erosive oesophagitis was categorised by the Los Angeles (LA) classification. Linear regression and receiver operating curve (ROC) analysis were performed to define optimal diagnostic cut-offs.ResultsProlonged, 96-hour pH studies were completed in 39 HCs (age 28 (18–53) years, 72% female) and 944 patients (age 46 (16–85) years, 65% female), of whom 136 (14.5%) had reflux oesophagitis. Median AET in HC was 1.3% (upper 95th percentile 4.6%) for any study day and 2.6% (upper 95th percentile 6.9%) for the worst day (24-hour period) during the study. ROC analysis for average AET differentiated HC from patients with moderate-to-severe oesophagitis (LA BCD; sensitivity 87%, specificity 95%, positive predictive value (PPV) 59%, negative predictive value 99% for a cut-off AET of 4.3%; area under the receiver operating curve 0.95). Specificity was higher, but PPV was substantially lower for severe oesophagitis (LA CD). ‘Worst-day’ analysis provided similar results; however, day-to-day variability was high.ConclusionDiagnostic thresholds for average AET were identified that accurately discriminate between HCs and patients with erosive oesophagitis. The findings provide conditional support for diagnostic criteria for GORD proposed by the Lyon Consensus. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|