Model to Select On-Therapy vs Off-Therapy Tests for Patients With Refractory Esophageal or Extraesophageal Symptoms

Gastroenterology
Dhyanesh A PatelMichael F Vaezi

Abstract

It is not clear whether we should test for reflux in patients with refractory heartburn or extraesophageal reflux (EER) symptoms, such as cough, hoarseness, or asthma. Guidelines recommend testing patients by pH monitoring when they are on or off acid-suppressive therapies based on pretest probability of reflux, determined by expert consensus. However, it is not clear what constitutes a low or high pretest probability of reflux in these patients. We aimed to develop a model that clinicians can use at bedside to estimate pretest probability of abnormal reflux. We performed a prospective study of 471 adult patients with refractory heartburn (n = 214) or suspected EER symptoms (n = 257) who underwent endoscopy with wireless pH monitoring while they were off acid-suppressive treatment and assigned them to groups based on symptoms at presentation (discovery cohort). Using data from the discovery cohort, we performed proportional odds ordinal logistic regression to select factors (easy to obtain demographic criteria and clinical symptoms such as heartburn, regurgitation, asthma, cough, and hoarseness) associated with esophageal exposure to acid. We validated our findings in a cohort of 118 patients with the same features from 2 separ...Continue Reading

Citations

Feb 13, 2019·Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery·Jerome R LechienMichael F Vaezi
Aug 10, 2020·The American Journal of Gastroenterology·C Prakash GyawaliRena H Yadlapati
Nov 13, 2020·Diseases of the Esophagus : Official Journal of the International Society for Diseases of the Esophagus·Rena YadlapatiSachin Wani
Mar 10, 2020·Gastrointestinal Endoscopy Clinics of North America·Caroline M BarrettMichael F Vaezi
May 23, 2021·Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association·Rena YadlapatiWalter W Chan
Nov 23, 2021·The American Journal of Gastroenterology·Philip O KatzStuart Jon Spechler

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