Development of the 24-hour intraesophageal pH monitoring composite scoring system

We describe in detail our logic for deriving a system to score 24-hour intraesophageal pH records of patients with gastroesophageal reflux. This system uses a uniform scoring unit and pH monitoring parameters taken from both the day and nighttime segments of the pH record. The score quantitates the degree of departure that a patient's reflux pattern exceeds physiologic reflux found in asymptomatic control volunteers, and directly correlates with the degree of reactive epithelial change characteristic of reflux esophagitis. Even though the scoring system was derived over 11 years ago, its logic and scoring principles are consistent with new concepts that concern the pathophysiology of gastroesophageal reflux disease.