Barbiera F

Accuracy of the water-siphon test associated to barium study in a high prevalence gastro-oesophageal reflux disease population: a novel statistical approach

RATIONALE, AIMS AND OBJECTIVESnGastro-oesophageal reflux disease (GORD) is a condition which develops when the reflux of gastric content causes troublesome symptoms or complications. Instrumental diagnostic tests generally used for GORD are 24-hour pH-metry and upper gastrointestinal (GI) endoscopy but barium study associated with provocative manoeuvres such as the water-siphon test (WST), has also been used for GORD. The aim of this paper was to estimate the accuracy of several tests in patients with GORD in a tertiary care setting, focusing on WST, which is rapid and non-invasive, simple to perform and well-tolerated by patients.nnnMETHODnA total of 172 consecutive patients, symptomatic for reflux referred to a tertiary medical centre, were considered and data regarding the WST, 24-hour pH-metry, upper GI endoscopy with histology were analysed using latent class analysis, a multivariable statistical method for estimating the accuracy of tests when a gold standard is not available.nnnRESULTSnThe overall proportion of GORD in the sample was estimated at 0.664 [95% confidence interval (CI) = (0.589; 0.731)]. WST proved to be the most sensitive [Se = 0.886; 95% CI = (0.688; 1.000)] compared with pH-metry [Se = 0.620; 95% CI = (0.493; 0.745)] and endoscopy with histology [Se = 0.534; 95% CI = (0.273; 0.789)]. It was less specific [Sp = 0.537; 95% CI = (0.003; 1.000)] than pH-metry [Sp = 0.547; 95% CI = (0.281; 0.813)], and even less than endoscopy with histology [Sp = 0.862; 95% CI = (0.495; 1.00)]. Positive predictive values were estimated at 0.792 [95% CI = (0.721; 0.862)] for WST, 0.731 [95% CI = (0.643; 0.819)] for pH-metry and 0.886 [95% CI = (0.811; 0.961)] for endoscopy with histology. Negative predictive values were estimated at 0.707 [95% CI = (0.573; 0.841)] for WST, 0.422 [95% CI = (0.310; 0.534)] for pH-metry and 0.484 [95% CI = (0.387; 0.581)] for endoscopy with histology.nnnCONCLUSIONnWater-siphon test might possibly be useful in patients with suspected GORD because it is highly sensitive and predictive. A positive outcome of the WST associated with a barium study can certainly justify upper GI endoscopy and support any pharmacological treatment of GORD.

Barium study associated with water siphon test in gastroesophageal reflux disease and its complications

PurposeThe aim of this study was to evaluate the role of digital cineradiography associated with the water siphon test (WST) in the diagnosis of gastroesophageal reflux and to compare the results with oesophageal motility study, pH monitoring and endoscopy associated with biopsy and histology.Materials and methodsOne hundred and sixty consecutive patients underwent digital cineradiography with WST, motility study, pH monitoring and endoscopy with biopsy. The presence of gastroesophageal reflux, oesophagitis, Barrett’s oesophagus and intestinal metaplasia was evaluated.ResultsWST vs. pH monitoring showed sensitivity of 71%, specificity of 31%, positive predictive value (PPV) of 53% and negative predictive value (NPV) of 50%; when middle-proximal refluxes only were considered, sensitivity decreased to 45% and specificity increased to 55%. Furthermore, the association between reflux and oesophagitis demonstrated by the chi-square (χ2) test proved to be statistically significant both for WST and pH monitoring, whereas the association between reflux and Barrett’s oesophagus was not significant for either WST or for pH monitoring. With regard to intestinal metaplasia, WST (middle-proximal refluxes) showed higher sensitivity (64% vs. 58%) and specificity (63% vs. 51%) than pH monitoring, whereas the statistical association between reflux and metaplasia proved to be significant for WST but not for pH monitoring.ConclusionsWST is a simple, inexpensive and reliable test that might be useful in the diagnosis of gastroesophageal reflux disease (GERD). A positive WST might be an additional indication for endoscopy with biopsy.RiassuntoObiettivoValutare il ruolo della videofluorografia con water siphon test (WST) nella diagnosi di reflusso gastroesofageo (GERD) comparandone i risultati con manometria, pH-metria ed endoscopia con biopsia e istologia.Materiali e metodiCentosessanta pazienti consecutivi sono stati sottoposti a videofluorografia digitale, manometria, pH-metria ed endoscopia con biopsia. È stata valutata la presenza di GERD, esofagite, esofago di Barrett e metaplasia intestinale.RisultatiIl WST vs. pH-metria ha presentato sensibilità del 71%, specificità del 31%, valore predittivo positivo (PPV) del 53% e valore predittivo negativo (NPV) del 50%; la sua specificità aumenta (55%) considerando solamente i reflussi medioprossimali, ma diminuisce la sensibilità (45%). Inoltre l’associazione reflusso-esofagite (test del chi-quadro) è risultata statisticamente significativa sia per il WST che per la pH-metria, mentre l’associazione reflusso-Barret non è risultata statisticamente significativa né per WST né per pH-metria. Rispetto alla metaplasia intestinale, il WST (reflussi medioprossimali) ha sensibilità (64% vs. 58%) e specificità (63% vs. 51%) maggiori rispetto alla pH-metria; l’associazione statistica tra reflusso e metaplasia è risultata significativa per il WST ma non per la pH-metria.ConclusioniIl WST è un test semplice e poco costoso, facilmente realizzabile, che può essere utile nella diagnosi di GERD; la sua positività può essere un indicatore per selezionare i pazienti da avviare all’endoscopia con biopsia.

Dysfunctional Disorders of the Pharynx and the Esophagus: VFSS and VFMSS

In the elderly there seems to be an increase in functional and motility disorders of the gastrointestinal tract. Among them dysphagia is one of the more serious conditions since it can lead to severe consequences, such as malnutrition, dehydration, aspiration pneumonia or airway obstruction.