Symptom association probability does not reliably distinguish functional heartburn from reflux hypersensitivity

Abstract

SummaryBackground: Symptom association probability (SAP) is thought to distinguish reflux

Revisiting Montreal: New Insights into Symptoms and Their Causes, and Implications for the Future of GERD

“…The same study also found that around 70% of patients who are refractory to PPIs have a reflux rate of <10% (37). A more recent study by Choski et al included a sub-group of patients with heartburn or regurgitation as their chief, PPI-refractory symptom (38). In this study, the difference between patients diagnosed with acid reflux hypersensitivity and those diagnosed with functional heartburn, in terms of the number of symptoms associated with reflux, equated to only 1‒2 pressings per day of the symptom reporting button (38).…”

“…A more recent study by Choski et al included a sub-group of patients with heartburn or regurgitation as their chief, PPI-refractory symptom (38). In this study, the difference between patients diagnosed with acid reflux hypersensitivity and those diagnosed with functional heartburn, in terms of the number of symptoms associated with reflux, equated to only 1‒2 pressings per day of the symptom reporting button (38). The authors did not include nonacid reflux in their assessments, pointing out that this increases the probability of chance associations between symptoms and reflux episodes (38).…”

“…The authors did not include nonacid reflux in their assessments, pointing out that this increases the probability of chance associations between symptoms and reflux episodes (38). Other factors that could influence the accuracy of SAP include the shorter duration of impedance-detected reflux events versus acid-detected events (39), longer lag times for symptom perception after weakly acidic versus acid reflux (40), the potential for unreliable reporting of symptom timing by patients (41) and day-to-day variation in the onset of symptoms (38).…”

Reflux hypersensitivity - what is in the name?

“…While SIs have been used for decades and treatment was provided accordingly, a few investigators have pointed out to some of their limitations and questioned their sensitivity. However, SIs are the best tool we have to identify the patients who are highly sensitive to physiologic amounts of reflux 27 .…”

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

“…4 In this issue of The Journal, Choki et al question the validity of this expanded usage, especially if used as an indication for anti-reflux surgery. 5…”