The Additional Role of Symptom-Reflux Association Analysis of Diagnosis of Gastroesophageal Reflux Disease Using Bravo Capsule pH Test

Kyoungwon Jung; Moo In Park; Seun Ja Park; Won Moon; Sung Eun Kim; Jae Hyun Kim

doi:10.4166/kjg.2017.70.4.169

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Jung, Park, Park, Moon, Kim, and Kim: The Additional Role of Symptom-Reflux Association Analysis of Diagnosis of Gastroesophageal Reflux Disease Using Bravo Capsule pH Test

Original Article

Korean J Gastroenterol 2017;70(4):169-175.

Published online: 4 October 2017

DOI: https://doi.org/10.4166/kjg.2017.70.4.169

The Additional Role of Symptom-Reflux Association Analysis of Diagnosis of Gastroesophageal Reflux Disease Using Bravo Capsule pH Test

Kyoungwon Jung, Moo In Park, Seun Ja Park, Won Moon, Sung Eun Kim, Jae Hyun Kim

Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea

Correspondence to: Moo In Park, Department of Internal Medicine, Kosin University College of Medicine, 262 Gamcheon-ro, Seo-gu, Busan 49267, Korea. Tel: +82-51-990-5205, Fax: +82-51-990-5055, E-mail: mipark@kosinmed.or.kr

Received 31 May 2017 Revised 15 July 2017 Accepted 31 July 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

Since the development of ambulatory esophageal pH monitoring test to diagnose gastroesophageal reflux disease (GERD), several parameters have been introduced. The aim of this study was to assess whether using the symptom index (SI), symptom sensitivity index (SSI), and symptom association probability (SAP), in addition to the DeMeester score (DS), would be useful for inter-preting the Bravo pH monitoring test.

Methods

A retrospective study, which included 68 patients with reflux symptoms refractory to proton pump inhibitor (PPI) therapy who underwent a Bravo capsule pH test between October 2006 and May 2015, was carried out. Acid reflux parameters and symptom reflux association parameters were analyzed.

Results

The median percent time of total pH<4 and DS were 2.90% (interquartile range [IQR] 1.13–6.03%) and 11.10 (IQR 4.90–22.80), respectively. According to the analysis of the day-to-day variation in percent time of total pH<4 (r=0.724) and DS (r=0.537), there was a significant correlation between Day 1 and Day 2. The positive rate of Bravo test according to DS was 27 (39.7%). Although thirty patients experienced symptoms during the test, there were no significant differences of reflux parameters compared with other patients. In the symptom group, 7 patients (23.3%) were identified as having negative DS and an abnormal symptom-related index. There were no significant test-related complications.

Conclusions

In addition to the analysis of traditional acid parameters of the Bravo capsule pH test, diagnosis of GERD, including reflux hypersensitivity, can be improved by performing an analysis of the symptom-reflux association and of the day-to-day variation.

Keywords: Bravo capsule pH test, Gastroesophageal reflux disease, Symptom-reflux association

References

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Fig. 1.

Flow chart of patients. PPI, proton pump inhibitor.

Fig. 2.

Correlation between Day 1 and Day 2 of the Bravo capsule pH test. (A) There was positive correlation between % time pH<4 of Day 1 and Day 2 (r=0.724, p<0.01). (B) There was positive correlation between DeMeester score of Day 1 and Day 2 (r=0.537, p<0.01). Coefficient of determination (R²) was calculated by linear regression.

Table 1.

Baseline Characteristics of Patients

Variable	n=68 (median, IQR)
Age (mean±SD)	50.3±12.4
Gender (%)
Male	26 (38.2)
Female	42 (61.8)
Total % time of pH<4: >5.8% (%) ^a	20 (29.4)
Total % time of pH<4	2.9 (1.0–6.9)
Upright % time of pH<4	3.5 (1.2–6.9)
Supine % time of pH<4	0.5 (0.0–3.1)
Total number of reflux episode	42.5 (23.0–72.8)
Number of reflux episodes>5 min	2.5 (1–6)
Longest time of reflux (min)	9 (5.0–27.3)
DeMeester score	10.8 (4.7–23.4)
DeMeester score>14.72 (%) ^a	33 (48.5)

IQR, interquartile range; SD, standard deviation.

^a Day 1 or Day 2.

Table 2.

Baseline Characteristics of Patients according to the Symptom Positivity

Variable	Positive symptom group (n=30)	Negative symptom group (n=38)	p-value
Age (mean±SD)	48.0±12.9	52.1±11.9	0.175
Gender (%)
Male	12 (46.2)	14 (53.8)
Female	18 (42.9)	24 (57.1)	0.807
Total % time of pH<4: >5.8% (%)^a	6 (20.0)	14 (36.8)	0.130
Total % time of pH<4	2.6 (1.2–3.8)	3.3 (1.0–8.3)	0.150
Upright % time of pH<4	2.6 (1.2–6.0)	4.2 (1.2–9.9)	0.154
Supine % time of pH<4	0.5 (0.0–2.3)	0.6 (0.0–3.6)	0.464
Total number of reflux episode	e 54 (25.3–79.3)	39 (21.3–67.3)	0.089
Number of reflux episodes>5	min 3 (1.0–5.3)	2 (0.0–6.0)	0.313
Longest time of reflux (min)	9 (5.0–18.8)	9 (4.0–31.5)	0.482
DeMeester score	9.9 (5.3–16.9)	13.2 (4.2–27.1)	0.197
DeMeester score>14.72 (%) ^a	15 (50.0)	18 (47.4)	0.829
% time of meal (mean±SD)	4.2±1.9	4.7±2.9	0.380

Unless otherwise noted, results presented as median (interquartile range). Analyses by t-test, Mann-Whitney U test, chi-square test. SD, standard deviation.

^a Day 1 or Day 2.

Table 3.

Subanalysis of Symptom-Reflux Association in the Symptom Positive Group (n=30)

Variable	Day 1	Day 2	Day 1 or Day 2^a
Total % time of pH<4: >5.8%	4	4	6 (20.0)
DeMeester score>14.72	10	8	15 (50.0)
SI≥50%	12	5	15 (50.0)
SSI≥10%	3	5	6 (20.0)
SAP≥95%	6	2	7 (23.3)
DeMeester score (negative, <14.72)+more than two abornmal findings among symtom-reflux association analysis (SI, SSI, SAP)	5	2	4 (13.3)

Values are presented as n or n (%)

SI, symptom index; SSI, symptom sensitivity index, SAP, symptom association probability.

^a Duplicate patients are removed in Day 1 or Day 2.

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