Five-Year Audit of Ambulatory 24-Hour Esophageal pH-Manometry in Clinical Practice

Netzer, Peter; Gut, A.; Heer, R.; Gries, N.; Pfister, M.; Halter, F; Inauen, W.

doi:10.1080/003655299750025877

Cited by 20 publications

(2 citation statements)

References 44 publications

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“…Patients with the main complaint of NCCP were less likely to have GERD (LR + 0.83, 0.43; LR- 1.13, 1.23) compared to patients with the main complaint of dysphagia (LR + 1.27, 1.16; LR- 0.97, 0.97) or GERD typical symptoms without chest pain (LR + 1.26, 1.53; LR- 0.93, 0.74) in two studies [25,26]. Two further studies compared the accuracy of NCCP and typical GERD symptoms (LR + 2.70 [27], 2.75 [24]; LR- 0.42 [24], 0.78 [27]) with NCCP without GERD symptoms (LR + 0.49; LR- 2.71 [24]) or with NCCP and a history of heart burn (LR + 2.15; LR- 0.74 [27]).…”

Section: Resultsmentioning

confidence: 99%

Diagnostic indicators of non-cardiovascular chest pain: a systematic review and meta-analysis

Wertli

Ruchti

Steurer

et al. 2013

BMC Med

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BackgroundNon-cardiovascular chest pain (NCCP) has a high healthcare cost, but insufficient guidelines exist for its diagnostic investigation. The objective of the present work was to identify important diagnostic indicators and their accuracy for specific and non-specific conditions underlying NCCP.MethodsA systematic review and meta-analysis were performed. In May 2012, six databases were searched. Hand and bibliography searches were also conducted. Studies evaluating a diagnostic test against a reference test in patients with NCCP were included. Exclusion criteria were having <30 patients per group, and evaluating diagnostic tests for acute cardiovascular disease. Diagnostic accuracy is given in likelihood ratios (LR): very good (LR+ >10, LR- <0.1); good (LR + 5 to 10, LR- 0.1 to 0.2); fair (LR + 2 to 5, LR- 0.2 to 0.5); or poor (LR + 1 to 2, LR- 0.5 to 1). Joined meta-analysis of the diagnostic test sensitivity and specificity was performed by applying a hierarchical Bayesian model.ResultsOut of 6,316 records, 260 were reviewed in full text, and 28 were included: 20 investigating gastroesophageal reflux disorders (GERD), 3 musculoskeletal chest pain, and 5 psychiatric conditions. Study quality was good in 15 studies and moderate in 13. GERD diagnosis was more likely with typical GERD symptoms (LR + 2.70 and 2.75, LR- 0.42 and 0.78) than atypical GERD symptoms (LR + 0.49, LR- 2.71). GERD was also more likely with a positive response to a proton pump inhibitor (PPI) test (LR + 5.48, 7.13, and 8.56; LR- 0.24, 0.25, and 0.28); the posterior mean sensitivity and specificity of six studies were 0.89 (95% credible interval, 0.28 to 1) and 0.88 (95% credible interval, 0.26 to 1), respectively. Panic and anxiety screening scores can identify individuals requiring further testing for anxiety or panic disorders. Clinical findings in musculoskeletal pain either had a fair to moderate LR + and a poor LR- or vice versa.ConclusionsIn patients with NCCP, thorough clinical evaluation of the patient’s history, symptoms, and clinical findings can indicate the most appropriate diagnostic tests. Treatment response to high-dose PPI treatment provides important information regarding GERD, and should be considered early. Panic and anxiety disorders are often undiagnosed and should be considered in the differential diagnosis of chest pain.

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Section: Resultsmentioning

confidence: 99%

Diagnostic indicators of non-cardiovascular chest pain: a systematic review and meta-analysis

Wertli

Ruchti

Steurer

et al. 2013

BMC Med

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“…By contrast, Hong et al [21] divided 462 patients into 4 symptom categories (dysphagia, noncardiac chest pain, gastroesophageal reflux disease-related, and extraesophageal symptoms) and stated that these categories are helpful in predicting the likelihood of abnormal manometric findings. A review of 315 consecutive patients who were evaluated with both 24-hour pH monitoring and 24-hour ambulatory manometry over a 5-year period found that manometry altered the diagnosis of 44% of these patients and changed the management of 66% of these patients [22]. Similarly, Lacy et al [23] reported that among 286 consecutive patients, new information was obtained in 87%, whereas a change in diagnosis occurred in 30% and in management in 44% of the patients after manometry.…”

Section: Discussionmentioning

confidence: 99%

Insights Gained from Symptom Evaluation of Esophageal Motility Disorders: A Review of 4,215 Patients

et al. 2012

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Background/Aims: Achalasia (Ach), diffuse esophageal spasm (DES), nutcracker esophagus (NE), and nonspecific motility disorder (NSMD) are described primary esophageal body motility disorders; however, their clinical symptom correlation is poorly understood. The aim of this study is to examine the association between a patient’s presenting symptoms and their manometric diagnosis. Methods: Manometric findings and reported symptoms of all patients undergoing esophageal manometry at the Creighton University Medical Center were prospectively entered in a database. Twenty-four-year data from 1984 through 2008 were accessed and analyzed. Results: Of the 4,215 patients, 130 (3.1%) had Ach, 192 (4.6%) had DES, 290 (6.9%) had NE, 508 (12.1%) had NSMD, and 3,095 (73.4%) had normal esophageal body motility. There was significant symptom overlap between the groups. Ach and DES had a similar symptom distribution, with dysphagia being the predominant symptom. Patients with NE, normal body motility, and NSMD presented predominantly with reflux symptoms. There was an increasing prevalence of esophageal dysmotility (DES and NSMD) with age, and women were found to be more likely to have NE than men. Conclusion: In an individual, reported symptoms do not correlate with their manometric diagnosis in a predictable fashion, and a thorough physiological assessment should be obtained to understand and diagnose the disease process. Esophageal motility deteriorates with age.

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Esophageal pH and Impedance Monitoring

Bardan

2012

Manual of Diagnostic and Therapeutic Techniques for Disorders of Deglutition

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Five-Year Audit of Ambulatory 24-Hour Esophageal pH-Manometry in Clinical Practice

Abstract: Combined 24-h pH-manometry has been shown to be a useful and cost-effective test for the management of selected patients in whom the primary investigation was insufficient.

Cited by 20 publications

References 44 publications

Diagnostic indicators of non-cardiovascular chest pain: a systematic review and meta-analysis

Diagnostic indicators of non-cardiovascular chest pain: a systematic review and meta-analysis

Insights Gained from Symptom Evaluation of Esophageal Motility Disorders: A Review of 4,215 Patients

Esophageal pH and Impedance Monitoring

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