Thresholds of gastroesophageal reflux in the diagnosis of esophageal reflux diseases

摘要

AIMS To establish optimal thresholds of pH variation (pH fluctuations and reflux episodes) in separating physiological and pathological gastroesophageal reflux(GER), and to evaluate their significance in the diagnosis of GER disease. METHODS Twenty-four-hour intraesophageal pH monitoring and endoscopy were performed in 400 patients with GER symptoms and in 100 healthy controls. RESULTS The results showed that the percentages of the time with pH fluctuations in patients with and without esophagitis, and in healthy controls were, on average, 12. 65%, 9. 5% and 2. 76% in 24h, respectively, and the respective percentages of the time with reflux episodes in the same groups in 24h were, on average, 3. 12%, 2.04% and 0. 18%, respectively. Using a receiver-operating-characteristic curve analysis, < 6. 7% of the time with pH fluctuations and < 0. 1% of the time with reflux episodes were defined as the combined thresholds for physiological versus pathological reflux. The sensitivity of the combuned thresholds for the detection of GER patients with and without esophagitis was 96. 7% and 90. 0%, respectively, and their specificity for the diagnosis of patients with abnormal GER disease was 100%. CONCLUSIONS pH fluctuations and reflux episodes, when e-valuated together, are more useful for classifying patients with GER and their combined thresholds yield higher diagnostic accuracy in assessing patients with GER disease.