Digestive Diseases and Sciences

, Volume 38, Issue 8, pp 1402–1408 | Cite as

The symptom index

Differential usefulness in suspected acid-related complaints of heartburn and chest pain
  • Swarnjit Singh
  • Joel E. Richter
  • Laurence A. Bradley
  • Julie M. Haile
Original Articles

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 

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References

  1. 1.
    DeMeester RT, Wang CI, Wernly JA, Pellegrini CA, Little AG, Klementschitsch P, Klementschitsch P, Bermudez G, Johnson LF, Skinner DB: Technique, indications, and clinical use of 24 hour esophageal pH monitoring. J Thorac Cardiac Surg 79:656–667, 1980Google Scholar
  2. 2.
    Richter JE: The symptom index: Correlation of acid reflux with symptoms.In Ambulatory Esophageal pH Monitoring: Practical Approach and Clinical Applications. JE Richter (ed). New York, Igaku-Shoin, 1991, pp 93–100Google Scholar
  3. 3.
    Ward BW, Wu WC, Richter JE, Lui KW, Castell DO: Ambulatory 24-hour esophageal pH monitoring: technology searching for a clinical application. J Clin Gastroenterol 8(suppl 1):59–67, 1986Google Scholar
  4. 4.
    Wiener GJ, Richter JE, Cooper JB, Wu WC, Castell DO: The symptom index: A clinically important parameter of ambulatory 24 hour esophageal pH monitoring. Am J Gastroenterol 83:358–361, 1988Google Scholar
  5. 5.
    Hewson EG, Sinclair JW, Dalton CB, Richter JE: Evaluation of 100 noncardiac chest pain patients finds 24-hour pH study to be the most useful diagnostic test. Gastroenterology 98:A58, 1990Google Scholar
  6. 6.
    Johnsson F, Joelsson B, Gudmundsonk, Greiff L: Symptoms and endoscopic findings in the diagnosis of gastroesophageal reflux disease. Scand J Gastroenterol 22:714–718, 1987Google Scholar
  7. 7.
    DeCaestecker JS, Heading RC: Esophageal pH monitoring. Gastroenterol Clin North Am 19:645–669, 1990Google Scholar
  8. 8.
    Marks R, Richter JE, Koehler R, Spenney J, Mills T: Does medical therapy improve dysphagia in patients with peptic strictures and esophagitis. Gastroenterology 102:A118, 1992Google Scholar
  9. 9.
    Cameron AJ, Linsmeister AR, Ballard DJ, Carney JA: Prevalence of columnar lined (Barrett's) esophagus. Comparison of population-based clinical and autopsy findings. Gastroenterology 99:918–922, 1990Google Scholar
  10. 10.
    Richter JE, Wu WC, Johns DN, Blackwell JN, Nelson JL, Castell JA, Castell DO: Esophageal manometry in 95 healthy adult volunteers: Variability of pressures with age and frequency of “abnormal” contractions. Dig Dis Sci 32:583–592, 1987Google Scholar
  11. 11.
    Johnson LR, DeMeester TR: Twenty-four hour pH monitoring of distal esophagus. Am J Gastroenterol 62:325–332, 1974Google Scholar
  12. 12.
    Richter JE, Bradley LA, DeMeester TR, Wu WC: Normal 24-hour ambulatory esophageal pH values: Influence of study center, pH electrode, age and gender. Dig Dis Sci 37:849–856, 1992Google Scholar
  13. 13.
    Schindlbeck NE, Heinrich C, Konig A, Dendorfer A, Pace F, Muller-Lissner SA: Optimal thresholds, sensitivity, and specificity of long-term pH-metry for the detection of gastroesophageal reflux disease. Gastroenterology 93:85–90, 1987Google Scholar
  14. 14.
    Murphy DW, Yuan Y, Castell DO: Does the intraesophageal pH probe accurately detect acid reflux? Dig Dis Sci 34:649–656, 1989Google Scholar
  15. 15.
    Kikendall JW, Johnson LF: Pill-induced esophageal injury.In The Esophagus. DO Castell, (ed). Boston, Little, Brown, 1992, pp 627–642Google Scholar
  16. 16.
    Mattox HE, Richter JE: Prolonged ambulatory esophageal pH monitoring in the evaluation of gastroesophageal reflux disease. Am J Med 89:345–356, 1990Google Scholar
  17. 17.
    Richter JE, Baldi F, Clouse RE, Diamant NE, Janssens J, Staiano A: Functional oesophageal diseases. Gastroenterol Int 5:3–17, 1992Google Scholar
  18. 18.
    Vantrappen G, Janssens G, Ghillebert G: The irritable oesophagus —a frequent cause of angina-like pain. Lancet 1:1232, 1987Google Scholar
  19. 19.
    Jones CM: Digestive Tract Pain. New York, Macmillan, 1958, pp 10–14Google Scholar
  20. 20.
    Orlando RC, Bozyniski EM: Heartburn in pernicious anemia. A consequence of bile reflux. N Engl J Med 289:522–523, 1973Google Scholar
  21. 21.
    Pulliam JJ, Bradley LA, Dalton CB, Salley AN, Richter JE: Role of psychological stress in gastroesophageal reflux disease. Gastroenterology 96:A401, 1989Google Scholar
  22. 22.
    Peters L, Maas L, Petty D, Dalton C, Penner D, Wu W, Castell DO, Richter JE: Spontaneous non-cardiac chest pain: Evaluation by 24 hour ambulatory esophageal motility and pH monitoring. Gastroenterology 94:878–886, 1988Google Scholar
  23. 23.
    Breumelhof R, Nadorp JHSM, Akkermans L, Smout AJPM: Analysis of 24-hour esophageal pressure and pH data in unselected patients with noncardiac chest pain. Gastroenterology 99:1257–1264, 1990Google Scholar

Copyright information

© Plenum Publishing Corporation 1993

Authors and Affiliations

  • Swarnjit Singh
    • 1
  • Joel E. Richter
    • 1
  • Laurence A. Bradley
    • 1
  • Julie M. Haile
    • 1
  1. 1.Division of GastroenterologyUniversity of Alabama at BirminghamBirmingham

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