Interobserver and Intraobserver Variability in pH-Impedance Analysis between 10 Experts and Automated Analysis

Loots, Clara M.; Wijk, Michiel P. van; Blondeau, Kathleen; Dalby, Kasper; Peeters, Laura; Rosen, Rachel; Salvatore, S.; Wenzl, Tobias G.; Vandenplas, Yvan; Benninga, Marc A.; Omari, Taher

doi:10.1016/j.jpeds.2011.08.017

Cited by 59 publications

(76 citation statements)

References 17 publications

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“…2,3,16 When symptom reflux association is negative both for acid and non-acid reflux in a patient with normal reflux the diagnosis of GERD is ruled out and anti-reflux surgery is no longer indicated as a therapeutic option. Automatic analysis by computer software has a rather low reliability for classifying patients as having positive or negative symptom reflux association because it overestimates reflux episodes 5,8,10 and especially weakly acid reflux, 5 when compared to manual analysis. This is why tracings are manually edited by a physician after automatic analysis, a routine which opens to possible inaccuracies due to intra and inter-observer variability, which have never been evaluated.…”

Section: Discussionmentioning

confidence: 99%

“…17 Our study investigated also intra-and inter-observer agreements on number of acid and non-acid reflux episodes. Previous studies have addressed this topic in the paediatric 8,9 and in the adult healthy 11 and GERD population, 10 although the 2 latter studies looked at inter-observer agreement only. Furthermore in the paper by Ravi et al 10 analysis was limited to classifying trac-ings with either normal or pathological number of reflux episodes.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore in the paper by Ravi et al 10 analysis was limited to classifying trac-ings with either normal or pathological number of reflux episodes. In the report by Loots et al 8 10 tracings were analysed and inter-observer agreement was calculated among 10 assessors whereas intra-observer agreement was measured among 3 of them. In the report by Pilic et al 9 24 tracings were analysed for inter-observer agreement and 6 for intra-observer agreement between 2 investigators.…”

Section: Discussionmentioning

confidence: 99%

“…Both a quantitative (i.e., number of reflux episodes) and a qualitative analysis (i.e., symptom reflux association) should be performed, the latter analysis having a higher relevance in PPI refractory patients who frequently have a normal number of reflux episodes. 2,3 Studies on intra-and inter-observer agreement of manual analysis are scanty, small, referred to the paediatric population or to healthy adults, [8][9][10][11] and they have focused on number of reflux episodes only.…”

Section: Introductionmentioning

confidence: 99%

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Impedance pH Monitoring: Intra-observer and Inter-observer Agreement and Usefulness of a Rapid Analysis of Symptom Reflux Association

Tenca¹,

Campagnola²,

Bravi³

et al. 2014

J Neurogastroenterol Motil

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Background/AimsSymptom reflux association analysis is especially helpful for evaluation and management of proton pump inhibitor (PPI) refractory patients. An accurate calculation requires manual editing of 24-hour multichannel intraluminal impedance-pH (MII-pH) tracings after automatic analysis. Intra-and inter-observer agreement as well as reliability of rapid editing confined to the time around symptomatic episodes are unknown. Aim of this study was to explore these topics in a prospective multicenter study. MethodsForty consecutive patients who were off PPI therapy underwent MII-pH recordings. After automatic analysis, their tracings were anonymized and randomized. Three experienced observers, each one trained in a different European center, independently performed manual editing of 24-hour tracings on 2 separate occasions. Values of symptom index and symptom association probability for acid and non acid reflux were transformed into binary response (i.e., positive or negative). ResultsIntra-observer agreement on symptom reflux association was 92.5% to 100.0% for acid and 85.0% to 97.5% for non-acid reflux. Inter-observer agreement was 100.0% for acid and 82.5% to 95.0% for non-acid reflux. Values for symptom index and symptom association probability were similar. Concordance between 24-hour and rapid (2 minutes-window before each symptomatic episode) editings for symptom reflux association occured in 39 to 40 patients (acid) and in 37 to 40 (non-acid), depending on the observer. ConclusionsIntra-and inter-observer agreement in classifying patients with or without symptom reflux association at manual editing of 24-hour tracings was high, especially for acid reflux. Classifying patients according to a rapid editing showed excellent concordance with the 24-hour one and can be adopted in clinical practice.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impedance pH Monitoring: Intra-observer and Inter-observer Agreement and Usefulness of a Rapid Analysis of Symptom Reflux Association

Tenca¹,

Campagnola²,

Bravi³

et al. 2014

J Neurogastroenterol Motil

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“…The intraluminal catheter also has a pH sensor. Thus, a combined esophageal multichannel intraluminal impedance-pH (MIIpH) technique may detect all GER episodes and classify GER episodes according to their pH value and proximal extension [9][10][11][12][13][14] .…”

mentioning

confidence: 99%

Detection of gastroesophageal reflux in children with cerebral palsy using combined multichannel intraluminal impedance-ph procedure

et al. 2016

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Gastroesophageal reflux (GER) is a very common condition in children with neurological impairment and this can influence nutritional and respiratory outcomes. The aim of this study was to investigate the presence of GER in children with cerebral palsy (CP) using multiple intraluminal impedance (MII)-pH monitoring. The use of combined MII-pH allows for the detection of both acid and non-acid reflux episodes. A total of 29 CP patients with symptoms suggesting GER, aged 2 to 10 years old, underwent 24-hour combined MII-pH monitoring. There were a total of 3899 reflux episodes, of which 29% were acid, 60% were weakly acid and 11% were alkaline. The number of non-acid reflux episodes was statistically significantly greater (p<0.01). These findings confirm that GER disease is seen frequently in children with cerebral palsy and most of the reflux episodes are not acidic. Non-acid reflux can also influence the morbidity in patients with cerebral palsy. It can be concluded that 70% of the reflux episodes would not have been recognized by pH measurement alone.

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Textbook of Pediatric Gastroenterology, Hepatology and Nutrition

2022

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Interobserver and Intraobserver Variability in pH-Impedance Analysis between 10 Experts and Automated Analysis

Cited by 59 publications

References 17 publications

Impedance pH Monitoring: Intra-observer and Inter-observer Agreement and Usefulness of a Rapid Analysis of Symptom Reflux Association

Impedance pH Monitoring: Intra-observer and Inter-observer Agreement and Usefulness of a Rapid Analysis of Symptom Reflux Association

Detection of gastroesophageal reflux in children with cerebral palsy using combined multichannel intraluminal impedance-ph procedure

Textbook of Pediatric Gastroenterology, Hepatology and Nutrition

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