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Related Concept Videos

Assessment of the Gastrointestinal System I: Subjective Data01:17

Assessment of the Gastrointestinal System I: Subjective Data

Assessing the gastrointestinal (GI) system is a complex process that begins with collecting subjective data. This data, collected through patient interviews, provides crucial insights into the patient's health history, perception patterns, and lifestyle habits, all contributing significantly to GI health.
Health History
The initial step in assessing the GI system is obtaining a comprehensive health history. This includes inquiring about the patient's history or presence of problems related to...
Gastroesophageal Reflux Disease II: Clinical Features and Management01:29

Gastroesophageal Reflux Disease II: Clinical Features and Management

Gastroesophageal reflux disease, or GERD, is a persistent medical condition that affects many individuals worldwide. Its clinical manifestations can vary greatly, making diagnosis and management challenging for healthcare professionals. The following is a comprehensive overview of the clinical manifestations, assessment, and management strategies for GERD.
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Imaging Studies III: Gastrointestinal Motility Studies and Virtual Colonoscopy01:26

Imaging Studies III: Gastrointestinal Motility Studies and Virtual Colonoscopy

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Gastroesophageal Reflux Disease01:25

Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (GERD) is the backward flow of stomach contents (acid, pepsin, or bile) into the esophagus, causing mucosal inflammation known as esophagitis. It results from failure of antireflux mechanisms, mainly the lower esophageal sphincter (LES), influenced by mechanical and physiological factors.Etiology and Risk FactorsGERD develops when LES function is weakened or when intra-abdominal pressure increases. Risk factors include aging, obesity, and sliding hiatal hernia,...
Assessment of the Gastrointestinal System II: Health Perception Pattern01:29

Assessment of the Gastrointestinal System II: Health Perception Pattern

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Related Experiment Video

Updated: Jul 17, 2026

Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring
06:46

Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring

Published on: December 14, 2020

Inter-Observer Variability of Gerd-Related Metrics on High-Resolution Manometry and Calculation of the Milan Score.

Marco Sozzi1, Stefano Siboni1, Andres R Latorre-Rodriguez2

  • 1Department of General and Emergency Surgery, IRCCS Policlinico San Donato, San Donato Milanese (Milano), Italy.

Neurogastroenterology and Motility
|July 16, 2026
PubMed
Summary

The Milan Score shows good inter-observer reproducibility for assessing gastroesophageal reflux disease (GERD) risk. However, standardization is needed for EGJ morphology and SLR maneuver components.

Keywords:
Milan score (MS)esophagogastric junction (EGJ)gastroesophageal reflux disease (GERD)high resolution manometry (HRM)inter‐observer variabilitystraight leg raise (SLR)

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Coordinate Mapping of Hyolaryngeal Mechanics in Swallowing
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Related Experiment Videos

Last Updated: Jul 17, 2026

Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring
06:46

Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring

Published on: December 14, 2020

Coordinate Mapping of Hyolaryngeal Mechanics in Swallowing
14:13

Coordinate Mapping of Hyolaryngeal Mechanics in Swallowing

Published on: May 6, 2014

Area of Science:

  • Gastroenterology
  • Esophageal Physiology
  • Diagnostic Accuracy

Background:

  • High-resolution manometry (HRM) is crucial for evaluating gastroesophageal reflux disease (GERD) risk.
  • The Milan Score (MS) integrates four HRM variables to predict GERD, but its reproducibility is unassessed.
  • Key components include EGJ morphology, EGJ contractile integral (EGJ-CI), ineffective esophageal motility (IEM), and straight leg raise (SLR) response.

Purpose of the Study:

  • To assess the inter-observer reproducibility of the Milan Score (MS) and its individual components.
  • To evaluate the diagnostic accuracy of the MS compared to pH-impedance studies.
  • To identify areas needing improved standardization in GERD risk assessment using HRM.

Main Methods:

  • Fifty HRM plots from suspected GERD patients were reviewed by 23 international esophageal experts.
  • Experts assessed EGJ morphology, EGJ-CI, IEM, and SLR response.
  • Inter-observer variability was quantified using Fleiss' κ and Kendall's W; MS accuracy was compared to MII-pH results.

Main Results:

  • Good agreement was found for the overall Milan Score (W=0.641) and IEM (κ=0.638), EGJ-CI (W=0.675).
  • Fair agreement for EGJ morphology (κ=0.321) and moderate agreement for SLR response (W=0.531) were observed.
  • Median concordance between MS and pH-impedance studies was 71.74%; median reader accuracy for MS was 64%.

Conclusions:

  • The Milan Score demonstrates good inter-observer reproducibility among international experts, supporting its clinical utility.
  • Heterogeneous agreement for individual parameters, particularly EGJ morphology and SLR, necessitates improved standardization.
  • Further refinement of these components may enhance the reliability of HRM-based GERD risk assessment.