An expert panel‐based study on recognition of gastro‐esophageal reflux in difficult esophageal pH‐impedance tracings
Background Despite existing criteria for scoring gastro‐esophageal reflux (GER) in esophageal multichannel pH‐impedance measurement (pH‐I) tracings, inter‐ and intra‐rater variability is large and agreement with automated analysis is poor. To identify parameters of difficult to analyze pH‐I patterns...
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| Veröffentlicht in: | Neurogastroenterology and motility 2015-05, Vol.27 (5), p.637-645 |
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| container_title | Neurogastroenterology and motility |
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| creator | Smits, M. J. Loots, C. M. Wijk, M. P. Bredenoord, A. J. Benninga, M. A. Smout, A. J. P. M. |
| description | Background
Despite existing criteria for scoring gastro‐esophageal reflux (GER) in esophageal multichannel pH‐impedance measurement (pH‐I) tracings, inter‐ and intra‐rater variability is large and agreement with automated analysis is poor. To identify parameters of difficult to analyze pH‐I patterns and combine these into a statistical model that can identify GER episodes with an international consensus as gold standard.
Methods
Twenty‐one experts from 10 countries were asked to mark GER presence for adult and pediatric pH‐I patterns in an online pre‐assessment. During a consensus meeting, experts voted on patterns not reaching majority consensus (>70% agreement). Agreement was calculated between raters, between consensus and individual raters, and between consensus and software generated automated analysis. With eight selected parameters, multiple logistic regression analysis was performed to describe an algorithm sensitive and specific for detection of GER.
Key Results
Majority consensus was reached for 35/79 episodes in the online pre‐assessment (interrater κ = 0.332). Mean agreement between pre‐assessment scores and final consensus was moderate (κ = 0.466). Combining eight pH‐I parameters did not result in a statistically significant model able to identify presence of GER. Recognizing a pattern as retrograde is the best indicator of GER, with 100% sensitivity and 81% specificity with expert consensus as gold standard.
Conclusions & Inferences
Agreement between experts scoring difficult impedance patterns for presence or absence of GER is poor. Combining several characteristics into a statistical model did not improve diagnostic accuracy. Only the parameter ‘retrograde propagation pattern’ is an indicator of GER in difficult pH‐I patterns.
Agreement between experts scoring difficult esophageal impedance patterns for presence or absence of gastro‐esophageal reflux is poor. Combining several characteristics into a statistical model did not improve diagnostic accuracy. Only the parameter ‘retrograde propagation pattern’ is indicative of GER on pH‐I tracings. |
| doi_str_mv | 10.1111/nmo.12536 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1832252381</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3662453311</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3866-bfd42989b22dc97ed0c6b23200476e792b784f1d5b2212b152073f9d3b45c9b23</originalsourceid><addsrcrecordid>eNqF0c1uFSEYBmBiauyPLryBhqQbu5gWPgYYlk2jtkm1G11PGGCONDMwhZm0p6tegtfolcjxtMaYGNlAwsObfLwIvaXkhJZ1GsZ4QoEz8QLtUSZ4BaqBnc2Zk4oq4LtoP-cbQoiAWrxCu8AlF4qxPfRwFrC7n1ya8aSDG348fu90dhbnebFrHANOzsRV8LMv59jjlc5zioW5HKdveuX0UEg_LPfYB2x933uzDDP-43q6KNyPk7M6GIfnpI0Pq_wavez1kN2bp_0Aff3w_sv5RXV1_fHy_OyqMqwRoup6W5d5VAdgjZLOEiM6YEBILYWTCjrZ1D21vAAKHeVAJOuVZV3NTXnFDtC7be6U4u3i8tyOPhs3DGXeuOSWNgyAA2vo_6mQvJFK1k2hR3_Rm7ikUAbZqLoRQNVGHW-VSTHn8k_tlPyo07qlpN1015bu2l_dFXv4lLh0o7O_5XNZBZxuwZ0f3PrfSe3nT9fbyJ_lV6Yr</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1674862198</pqid></control><display><type>article</type><title>An expert panel‐based study on recognition of gastro‐esophageal reflux in difficult esophageal pH‐impedance tracings</title><source>MEDLINE</source><source>Wiley Free Content</source><source>Wiley Online Library All Journals</source><creator>Smits, M. J. ; Loots, C. M. ; Wijk, M. P. ; Bredenoord, A. J. ; Benninga, M. A. ; Smout, A. J. P. M.</creator><creatorcontrib>Smits, M. J. ; Loots, C. M. ; Wijk, M. P. ; Bredenoord, A. J. ; Benninga, M. A. ; Smout, A. J. P. M.</creatorcontrib><description>Background
Despite existing criteria for scoring gastro‐esophageal reflux (GER) in esophageal multichannel pH‐impedance measurement (pH‐I) tracings, inter‐ and intra‐rater variability is large and agreement with automated analysis is poor. To identify parameters of difficult to analyze pH‐I patterns and combine these into a statistical model that can identify GER episodes with an international consensus as gold standard.
Methods
Twenty‐one experts from 10 countries were asked to mark GER presence for adult and pediatric pH‐I patterns in an online pre‐assessment. During a consensus meeting, experts voted on patterns not reaching majority consensus (>70% agreement). Agreement was calculated between raters, between consensus and individual raters, and between consensus and software generated automated analysis. With eight selected parameters, multiple logistic regression analysis was performed to describe an algorithm sensitive and specific for detection of GER.
Key Results
Majority consensus was reached for 35/79 episodes in the online pre‐assessment (interrater κ = 0.332). Mean agreement between pre‐assessment scores and final consensus was moderate (κ = 0.466). Combining eight pH‐I parameters did not result in a statistically significant model able to identify presence of GER. Recognizing a pattern as retrograde is the best indicator of GER, with 100% sensitivity and 81% specificity with expert consensus as gold standard.
Conclusions & Inferences
Agreement between experts scoring difficult impedance patterns for presence or absence of GER is poor. Combining several characteristics into a statistical model did not improve diagnostic accuracy. Only the parameter ‘retrograde propagation pattern’ is an indicator of GER in difficult pH‐I patterns.
Agreement between experts scoring difficult esophageal impedance patterns for presence or absence of gastro‐esophageal reflux is poor. Combining several characteristics into a statistical model did not improve diagnostic accuracy. Only the parameter ‘retrograde propagation pattern’ is indicative of GER on pH‐I tracings.</description><identifier>ISSN: 1350-1925</identifier><identifier>EISSN: 1365-2982</identifier><identifier>DOI: 10.1111/nmo.12536</identifier><identifier>PMID: 25756933</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Adult ; Automation ; Child ; consensus meeting ; Diagnosis, Computer-Assisted ; difficult impedance tracings ; Electric Impedance ; esophageal ; Esophageal pH Monitoring ; expert panel ; Gastroenterology ; Gastroesophageal Reflux - diagnosis ; gastro‐esophageal reflux ; Humans ; Logistic Models ; Observer Variation ; Pattern Recognition, Automated - methods ; pH‐impedance ; Sensitivity and Specificity</subject><ispartof>Neurogastroenterology and motility, 2015-05, Vol.27 (5), p.637-645</ispartof><rights>2015 John Wiley & Sons Ltd</rights><rights>2015 John Wiley & Sons Ltd.</rights><rights>Copyright © 2015 John Wiley & Sons Ltd</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3866-bfd42989b22dc97ed0c6b23200476e792b784f1d5b2212b152073f9d3b45c9b23</citedby><cites>FETCH-LOGICAL-c3866-bfd42989b22dc97ed0c6b23200476e792b784f1d5b2212b152073f9d3b45c9b23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fnmo.12536$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fnmo.12536$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>309,310,314,780,784,789,790,1416,1432,23928,23929,25138,27922,27923,45572,45573,46407,46831</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25756933$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Smits, M. J.</creatorcontrib><creatorcontrib>Loots, C. M.</creatorcontrib><creatorcontrib>Wijk, M. P.</creatorcontrib><creatorcontrib>Bredenoord, A. J.</creatorcontrib><creatorcontrib>Benninga, M. A.</creatorcontrib><creatorcontrib>Smout, A. J. P. M.</creatorcontrib><title>An expert panel‐based study on recognition of gastro‐esophageal reflux in difficult esophageal pH‐impedance tracings</title><title>Neurogastroenterology and motility</title><addtitle>Neurogastroenterol Motil</addtitle><description>Background
Despite existing criteria for scoring gastro‐esophageal reflux (GER) in esophageal multichannel pH‐impedance measurement (pH‐I) tracings, inter‐ and intra‐rater variability is large and agreement with automated analysis is poor. To identify parameters of difficult to analyze pH‐I patterns and combine these into a statistical model that can identify GER episodes with an international consensus as gold standard.
Methods
Twenty‐one experts from 10 countries were asked to mark GER presence for adult and pediatric pH‐I patterns in an online pre‐assessment. During a consensus meeting, experts voted on patterns not reaching majority consensus (>70% agreement). Agreement was calculated between raters, between consensus and individual raters, and between consensus and software generated automated analysis. With eight selected parameters, multiple logistic regression analysis was performed to describe an algorithm sensitive and specific for detection of GER.
Key Results
Majority consensus was reached for 35/79 episodes in the online pre‐assessment (interrater κ = 0.332). Mean agreement between pre‐assessment scores and final consensus was moderate (κ = 0.466). Combining eight pH‐I parameters did not result in a statistically significant model able to identify presence of GER. Recognizing a pattern as retrograde is the best indicator of GER, with 100% sensitivity and 81% specificity with expert consensus as gold standard.
Conclusions & Inferences
Agreement between experts scoring difficult impedance patterns for presence or absence of GER is poor. Combining several characteristics into a statistical model did not improve diagnostic accuracy. Only the parameter ‘retrograde propagation pattern’ is an indicator of GER in difficult pH‐I patterns.
Agreement between experts scoring difficult esophageal impedance patterns for presence or absence of gastro‐esophageal reflux is poor. Combining several characteristics into a statistical model did not improve diagnostic accuracy. Only the parameter ‘retrograde propagation pattern’ is indicative of GER on pH‐I tracings.</description><subject>Adult</subject><subject>Automation</subject><subject>Child</subject><subject>consensus meeting</subject><subject>Diagnosis, Computer-Assisted</subject><subject>difficult impedance tracings</subject><subject>Electric Impedance</subject><subject>esophageal</subject><subject>Esophageal pH Monitoring</subject><subject>expert panel</subject><subject>Gastroenterology</subject><subject>Gastroesophageal Reflux - diagnosis</subject><subject>gastro‐esophageal reflux</subject><subject>Humans</subject><subject>Logistic Models</subject><subject>Observer Variation</subject><subject>Pattern Recognition, Automated - methods</subject><subject>pH‐impedance</subject><subject>Sensitivity and Specificity</subject><issn>1350-1925</issn><issn>1365-2982</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqF0c1uFSEYBmBiauyPLryBhqQbu5gWPgYYlk2jtkm1G11PGGCONDMwhZm0p6tegtfolcjxtMaYGNlAwsObfLwIvaXkhJZ1GsZ4QoEz8QLtUSZ4BaqBnc2Zk4oq4LtoP-cbQoiAWrxCu8AlF4qxPfRwFrC7n1ya8aSDG348fu90dhbnebFrHANOzsRV8LMv59jjlc5zioW5HKdveuX0UEg_LPfYB2x933uzDDP-43q6KNyPk7M6GIfnpI0Pq_wavez1kN2bp_0Aff3w_sv5RXV1_fHy_OyqMqwRoup6W5d5VAdgjZLOEiM6YEBILYWTCjrZ1D21vAAKHeVAJOuVZV3NTXnFDtC7be6U4u3i8tyOPhs3DGXeuOSWNgyAA2vo_6mQvJFK1k2hR3_Rm7ikUAbZqLoRQNVGHW-VSTHn8k_tlPyo07qlpN1015bu2l_dFXv4lLh0o7O_5XNZBZxuwZ0f3PrfSe3nT9fbyJ_lV6Yr</recordid><startdate>201505</startdate><enddate>201505</enddate><creator>Smits, M. J.</creator><creator>Loots, C. M.</creator><creator>Wijk, M. P.</creator><creator>Bredenoord, A. J.</creator><creator>Benninga, M. A.</creator><creator>Smout, A. J. P. M.</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>201505</creationdate><title>An expert panel‐based study on recognition of gastro‐esophageal reflux in difficult esophageal pH‐impedance tracings</title><author>Smits, M. J. ; Loots, C. M. ; Wijk, M. P. ; Bredenoord, A. J. ; Benninga, M. A. ; Smout, A. J. P. M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3866-bfd42989b22dc97ed0c6b23200476e792b784f1d5b2212b152073f9d3b45c9b23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adult</topic><topic>Automation</topic><topic>Child</topic><topic>consensus meeting</topic><topic>Diagnosis, Computer-Assisted</topic><topic>difficult impedance tracings</topic><topic>Electric Impedance</topic><topic>esophageal</topic><topic>Esophageal pH Monitoring</topic><topic>expert panel</topic><topic>Gastroenterology</topic><topic>Gastroesophageal Reflux - diagnosis</topic><topic>gastro‐esophageal reflux</topic><topic>Humans</topic><topic>Logistic Models</topic><topic>Observer Variation</topic><topic>Pattern Recognition, Automated - methods</topic><topic>pH‐impedance</topic><topic>Sensitivity and Specificity</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Smits, M. J.</creatorcontrib><creatorcontrib>Loots, C. M.</creatorcontrib><creatorcontrib>Wijk, M. P.</creatorcontrib><creatorcontrib>Bredenoord, A. J.</creatorcontrib><creatorcontrib>Benninga, M. A.</creatorcontrib><creatorcontrib>Smout, A. J. P. M.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Neurogastroenterology and motility</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Smits, M. J.</au><au>Loots, C. M.</au><au>Wijk, M. P.</au><au>Bredenoord, A. J.</au><au>Benninga, M. A.</au><au>Smout, A. J. P. M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>An expert panel‐based study on recognition of gastro‐esophageal reflux in difficult esophageal pH‐impedance tracings</atitle><jtitle>Neurogastroenterology and motility</jtitle><addtitle>Neurogastroenterol Motil</addtitle><date>2015-05</date><risdate>2015</risdate><volume>27</volume><issue>5</issue><spage>637</spage><epage>645</epage><pages>637-645</pages><issn>1350-1925</issn><eissn>1365-2982</eissn><abstract>Background
Despite existing criteria for scoring gastro‐esophageal reflux (GER) in esophageal multichannel pH‐impedance measurement (pH‐I) tracings, inter‐ and intra‐rater variability is large and agreement with automated analysis is poor. To identify parameters of difficult to analyze pH‐I patterns and combine these into a statistical model that can identify GER episodes with an international consensus as gold standard.
Methods
Twenty‐one experts from 10 countries were asked to mark GER presence for adult and pediatric pH‐I patterns in an online pre‐assessment. During a consensus meeting, experts voted on patterns not reaching majority consensus (>70% agreement). Agreement was calculated between raters, between consensus and individual raters, and between consensus and software generated automated analysis. With eight selected parameters, multiple logistic regression analysis was performed to describe an algorithm sensitive and specific for detection of GER.
Key Results
Majority consensus was reached for 35/79 episodes in the online pre‐assessment (interrater κ = 0.332). Mean agreement between pre‐assessment scores and final consensus was moderate (κ = 0.466). Combining eight pH‐I parameters did not result in a statistically significant model able to identify presence of GER. Recognizing a pattern as retrograde is the best indicator of GER, with 100% sensitivity and 81% specificity with expert consensus as gold standard.
Conclusions & Inferences
Agreement between experts scoring difficult impedance patterns for presence or absence of GER is poor. Combining several characteristics into a statistical model did not improve diagnostic accuracy. Only the parameter ‘retrograde propagation pattern’ is an indicator of GER in difficult pH‐I patterns.
Agreement between experts scoring difficult esophageal impedance patterns for presence or absence of gastro‐esophageal reflux is poor. Combining several characteristics into a statistical model did not improve diagnostic accuracy. Only the parameter ‘retrograde propagation pattern’ is indicative of GER on pH‐I tracings.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>25756933</pmid><doi>10.1111/nmo.12536</doi><tpages>9</tpages></addata></record> |
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| ispartof | Neurogastroenterology and motility, 2015-05, Vol.27 (5), p.637-645 |
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| source | MEDLINE; Wiley Free Content; Wiley Online Library All Journals |
| subjects | Adult Automation Child consensus meeting Diagnosis, Computer-Assisted difficult impedance tracings Electric Impedance esophageal Esophageal pH Monitoring expert panel Gastroenterology Gastroesophageal Reflux - diagnosis gastro‐esophageal reflux Humans Logistic Models Observer Variation Pattern Recognition, Automated - methods pH‐impedance Sensitivity and Specificity |
| title | An expert panel‐based study on recognition of gastro‐esophageal reflux in difficult esophageal pH‐impedance tracings |
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