Editorial: symptom association probability during reflux testing—what is the gain?

Abstract

Editorial: symptom association probability during reflux testing-what is the gain?Reflux monitoring is indicated for patients with suspected refractory reflux symptoms, but without convincing oesophagitis on endoscopy.1 Significantly abnormal acid exposure (ie > 6%) equates to a diagnosis of gastro-oesophageal reflux disease (GERD). 2 However that begs the question of whether or not the refractory symptoms are reflux-related. The symptom index (SI) and symptom association probability (SAP) were developed to address that question. ACKNOWLEDG EMENTSDeclaration of personal interests: None. FUNDING INFORMATION None.O R C I D J. R. Triggs http://orcid.org/0000-0002-2692-6077 P. J. Kahrilas

Prevalence of Non-erosive Esophageal Phenotypes in Children: A European Multicenter Study

“…22 Nevertheless, it is widely recognized that the fewer the number of symptoms reported, the less reliable the SAP becomes. 23 Thus, in our study we considered as not-reliable SAP when the symptom was reported less than 3 times during the MII-pH. Based on MII-pH results, we categorized the enrolled patients in 4 subgroups: (1) The post reflux swallow induced peristaltic wave (PSPW) was defined as an antegrade 50% drop in impedance starting in the most proximal impedance channel and reaching the most distal impedance channel, occurring within 30 seconds after a reflux event.…”

“… 22 Nevertheless, it is widely recognized that the fewer the number of symptoms reported, the less reliable the SAP becomes. 23 Thus, in our study we considered as not-reliable SAP when the symptom was reported less than 3 times during the MII-pH. Based on MII-pH results, we categorized the enrolled patients in 4 subgroups: (1) abnormal RI (NERD); (2) normal RI and abnormal SAP (RH); (3) normal RI and normal SAP (FH); and (4) normal RI and not-reliable SAP (normal RI not otherwise specified [“normal RI-NOS”]).…”

Consenso latinoamericano de diagnóstico de la enfermedad por reflujo gastroesofágico

“…17 Sin embargo, esto no responde la pregunta de si los síntomas están o no relacionados con el reflujo. 186 El IS y el SAP fueron desarrollados para responder esta pregunta. 187 Es muy importante tener en cuenta que estas métricas surgieron para la pH-metría sin monitoreo de impedancia y para los síntomas típicos de reflujo (pirosis, dolor torácico y regurgitación).…”

“…204 A partir de esta publicación, dos editoriales cuestionaron el valor de la utilización de los índices sintomáticos para el diagnóstico de ERGE. 186,205 Posteriormente, Spechler y col. publicaron en el año 2019 un osado ensayo clínico aleatorizado, en el que eva-luaron el tratamiento médico versus el quirúrgico. Incluyeron a 78 pacientes altamente seleccionados con pirosis refractaria y SAP positiva (ERGE e hipersensibilidad al reflujo).…”

German Respiratory Society guidelines for diagnosis and treatment of adults suffering from acute, subacute and chronic cough

“…A causality of the cough with confirmed reflux can be assumed if there is a high symptom association probability (SAP) of >95% with cough episodes [69]. However, not all patients performing pH-probe are able to fully record their cough episodes by manual signal input at the device [70,71]. The lower the number of reflux episodes, the more likely an overinterpretation of an apparently high SAP [72].…”