Does the pHoenix score reduce the inconclusive GERD diagnosis: a net reclassification index analysis.

内容摘要

Acid exposure time (AET) yields inconclusive results in 10%-15% of patients undergoing 24-h ambulatory pH-impedance monitoring (multichannel intraluminal impedance-pH, MII-pH) for suspected gastroesophageal reflux disease (GERD), delaying diagnosis and appropriate management. The pHoenix score (pHx-s) was developed to reduce this diagnostic uncertainty. Its performance in Latin American populations remains uncharacterized. Net reclassification index (NRI) analysis based on a retrospective cohort. A cohort of symptomatic adults who underwent high-resolution manometry, MII-pH, and upper endoscopy at Hospital Universitario San Ignacio, Bogot&#xe1; (Colombia) was included. pHx-s was calculated as (upright AET&#x2009;&#xd7;&#x2009;0.991)&#x2009;+&#x2009;(supine AET&#x2009;&#xd7;&#x2009;1.286) and classified as normal (<7.06), borderline (7.06-8.45), or pathological (>8.45). Diagnostic performance and area under the receiver operating curve (AUC) were calculated. DeMeester score (>14.7) served as the reference standard. NRI analysis is presented independently for patients with and without confirmed GERD. 292 patients were included in the analysis (Median 61&#x2009;years, 71.2% female, 79.1% with hiatal hernia (HH)). The AUC of pHx-s was 0.98 (0.963-0.992). At the lower threshold (7.06), sensitivity was 95.7% and specificity 99.1%; at the upper (&#x2a7e;8.45), sensitivity 89.8%, and specificity 100%. pHx-s reduced inconclusive results from 13.0% (using exclusively AET criteria) to 4.1% (-68.5%, p&#x2009;<&#x2009;0.001). Among inconclusive AET cases, pHx-s reassigned 55.3% as pathological and 18.4% as normal, with an overall NR improvement of 14.6%. In this Latin American cohort with a high prevalence of HH, pHx-s substantially reduced inconclusive GERD diagnoses and demonstrated excellent performance compared with the DeMeester score. These findings support the use of the pHx-s in diverse clinical settings. Can the pHoenix score help reduce unclear GERD diagnoses? Diagnosing gastroesophageal reflux disease (GERD) can be difficult because the standard test gives unclear results in some patients. The pHoenix score is a newer tool designed to reduce this uncertainty. In this study, we evaluated the pHoenix score in 292 adults from Colombia who underwent testing for GERD. The score showed excellent accuracy and reduced unclear results from 13% to 4.1%. It also helped reclassify many patients whose initial test results were inconclusive. These findings suggest that the pHoenix score may help doctors diagnose GERD more clearly and guide treatment more effectively. Further studies in other populations are needed.