Disagreement between symptom-reflux association analysis parameters in pediatric gastroesophageal reflux disease...

Area of Science:

• Pediatric Gastroenterology
• Diagnostic Accuracy Studies
• Infant Health

Background:

• Gastroesophageal reflux disease (GERD) is common in infants, presenting diagnostic challenges.
• Symptom-reflux association analysis (SAA) parameters like Symptom Index (SI), Symptom Sensitivity Index (SSI), and Symptom Association Probability (SAP) are used to investigate GERD.
• Reliable interpretation of SAA is crucial for accurate GERD diagnosis in infants.

Purpose of the Study:

• To evaluate the agreement among three common SAA parameters (SI, SSI, SAP) in infants with suspected GERD.
• To assess the diagnostic classification concordance of these SAA parameters using combined pH/multiple intraluminal impedance (MII) monitoring.
• To identify potential limitations in SAA for infant GERD diagnosis.

Main Methods:

• Twenty-three infants with suspected GERD underwent 24-hour combined pH/MII monitoring.
• SI, SSI, and SAP were calculated for symptoms of cough and irritability.
• SAA parameter results were classified as normal or abnormal based on defined cut-off values.

Main Results:

• Significant disagreement was observed between SI, SSI, and SAP in classifying GERD in infants.
• When evaluating irritability, non-identical classifications occurred in 39.2% of infants, with poor inter-parameter association (Kendall's tau b < 0.05).
• When evaluating cough, non-identical classifications occurred in 52.2% of infants, with poor association between SI and SSI (Kendall's tau b < 0.05).

Conclusions:

• SI, SSI, and SAP demonstrate poor inter-parameter association and significant disagreements in diagnostic classification for infant GERD.
• The limitations and variability in SAA results must be considered when interpreting data in infants.
• Further research may be needed to refine SAA methods or explore alternative diagnostic approaches for infant GERD.