Gastroesophageal reflux (GER), defined as passage of gastric contents into the esophagus is a normal process that occurs in healthy infants, children and adults. When GER causes troublesome symptoms and/or complications it is referred to as gastroesophageal reflux disease (GERD). During infancy, GER is common and can manifest with specific symptoms as vomiting and non-specific symptoms as irritability and cough. Association of non-specific symptoms with GER is a main problem in the diagnosis of GERD. Timely association of GER episodes and symptom episodes are expressed by symptom-reflux association analysis (SAA) parameters. Abnormal results of SAA parameters point towards GERD. Three SAA parameters are commonly used, symptom index (SI), symptom sensitivity index (SSI) and symptom association probability (SAP). The agreement of these 3 SAA parameters has never been investigated in the infant population.
A research article to be published on May 21, 2010 in the World Journal of Gastroenterology addresses this question. A research team led by Professor Samuel C Lüthold, investigated infants with suspected GERD presenting with irritability and cough, using combined pH/MII monitoring.
Evaluating the irritability-GER association, SI, SSI and SAP showed a non-identical classification in almost 40% of infants. Evaluating the cough-GER association SI, SSI and SAP showed a non-identical classification in over 50% of infants. The study showed that the results of SI, SSI and SAP for the diagnosis of GERD often differ. In consequence, the diagnosis of GERD in infants cannot be based on a single SAA parameter as it remains unknown which SAA parameter is the most accurate for the diagnosis of GERD.
The authors suggest that the diagnosis of GERD should be based on a combination of pH/MII-monitoring, SAA results as well as on other factors such as clinical judgment, gastroscopy and follow-up under medical therapy. Validation studies to enhance the accuracy of SAA parameters and to answer the question which SAA parameter is the most accurate are needed.
Reference: Lüthold SC, Rochat MK, Bähler P. Disagreement between symptom-reflux association analysis parameters in pediatric gastroesophageal reflux disease investigation. World J Gastroenterol 2010; 16(19): 2401-2406
Correspondence to: Samuel C Lüthold, MD, Division of Gastroenterology, Departement of Pediatrics, Hospital of Fribourg, CH-1708 Fribourg, Switzerland. firstname.lastname@example.org
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About World Journal of Gastroenterology
World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H. pylori infection and provides a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health. ISI JCR 2008 IF: 2.081. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th day of every month. WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the name of China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.