Original Articles

Digestive Diseases and Sciences

, Volume 38, Issue 8, pp 1402-1408

The symptom index

Differential usefulness in suspected acid-related complaints of heartburn and chest pain
  • Swarnjit SinghAffiliated withDivision of Gastroenterology, University of Alabama at Birmingham
  • , Joel E. RichterAffiliated withDivision of Gastroenterology, University of Alabama at Birmingham
  • , Laurence A. BradleyAffiliated withDivision of Gastroenterology, University of Alabama at Birmingham
  • , Julie M. HaileAffiliated withDivision of Gastroenterology, University of Alabama at Birmingham

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Abstract

The symptom index is a quantitative measure developed for assessing the relationship between gastroesophageal reflux and symptoms. Controversy exists, however, over its accuracy and the appropriate threshold for defining acid-related symptoms of heartburn and chest pain. Therefore, a retrospective review was done of 153 consecutive patients referred to our esophageal laboratory. Three groups were identified: patients with normal 24-hr pH tests and no esophagitis, patients with abnormal 24-hr pH tests and no esophagitis, and patients with abnormal 24 hr pH values and endoscopic esophagitis. If symptoms occurred during the pH study, a symptom index (number of acid related symptoms/total number of symptoms x 100%) was calculated separately for heartburn and chest pain. Heartburn and chest pain episodes were similar among the three groups. However, the mean symptom index for heartburn was significantly (P<0.001) higher in the patient groups with abnormal pH values [abnormal pH/no esophagitis: 70±7.1% (±se); abnormal pH/esophagitis: 85±4.6%] as compared to those with normal studies, ie, functional heartburn (26±10.7%). The mean symptom index for chest pain was similar for all three groups. Using receiver operating characteristic curves, a heartburn symptom index≥50% had excellent sensitivity (93%) and good specificity (71%) for acid reflux disease, especially if patients complain of multiple episoldes of heartburn. In contrast, an optimal symptom index threshold for defining acid-related chest pain episodes could not be defined.

Key Words

heartburn chest pain gastroesophageal reflux disease 24-hr esophageal pH test symptom index