What is the optimal time window in symptom analysis of 24-hour esophageal pressure and pH data?
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Since noncardiac chest pain is the only well-established indication for 24-hr esophageal pH and pressure recording, the analysis of the association between chest pain episodes and esophageal motility abnormalities or reflux is the most important part of data analysis in 24-hr monitoring. Until now, different time windows have arbitrarily been used by various research groups. The aim of this study was to determine the optimal time window for symptom analysis in 24-hr esophageal pH and pressure monitoring. For this purpose repetitive symptom association analysis was carried out, using time windows of various onsets and durations. For each time window, the symptom indices for reflux and dysmotility were calculated. The symptom index for both reflux and dysmotility showed a gradual increase for windows with increasingly early onset, following a pattern that would be predicted on the basis of Poisson's theory. However, both indices had a relatively sharp cutoff point at 2 min before the onset of pain. Both indices only showed a predictable gradual increase when the time window starting at −2 min was extended beyond the moment of pain onset. It is concluded that the optimal time window for symptom analysis in 24-hr esophageal pH and pressure recording begins at 2 min before the onset of pain and ends at the onset of pain.
Key wordsnoncardiac chest pain gastroesophageal reflux esophageal motor abnormalities 24-hour pressure recording pH recording time windows symptom analysis
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- 1.Janssens J, Vantrappen G, Ghillebert G: 24-Hour recording of esophageal pressure and pH in patients with noncardiac chest pain. Gastroenterology 90:1978–1984, 1986Google Scholar
- 2.Peters L, Maas L, Petty D, Dalton C, Penner D, Wu W, Castell DO, Richter JE: Spontaneous noncardiac chest pain. Evaluation by 24-hour ambulatory esophageal motility and pH monitoring. Gastroenterology 94:878–886, 1988Google Scholar
- 3.Soffer EE, Scalabrini P, Wingate DL: Spontaneous noncardiac chest pain: Value of ambulatory esophageal pH and motility monitoring. Dig Dis Sci 34:1651–1655, 1989Google Scholar
- 4.Richter JE, Castell DO: 24-Hour ambulatory oesophageal motility monitoring: How should motility data be analyzed? Gut 30:1040–1047, 1989Google Scholar
- 5.Breumelhof R, Nadorp JHSM, Akkermans LMA, Smout AJPM: Analysis of 24-hour esophageal pressure and pH data in unselected patients with noncardiac chest pain. Gastroenterology 99:1257–1264, 1990Google Scholar
- 6.Ghillebert G, Janssens J, Vantrappen G, Nevens F, Piessens J: Ambulatory 24 hour intraoesophageal pH and pressure recordings, versus provocation tests in the diagnosis of chest pain of oesophageal origin. Gut 31:738–744, 1990Google Scholar
- 7.Lam HGT, Dekker W, Kan G, Breedijk M, Smout AJPM: Acute noncardiac chest pain in a coronary care unit: evaluation by 24-hour pressure and pH recording of the esophagus. Gastroenterology 102:453–460, 1992Google Scholar
- 8.Smout AJPM, Breedijk M, van der Zouw C, Akkermans LMA: Physiological gastroesophageal reflux and esophageal motor activity studied with a new system for 24-hour recording and automated analysis. Dig Dis Sci 34:372–378, 1989Google Scholar
- 9.Bumm R, Emde C, Armstrong D, Bauerfeind P, Blum AL: Ambulatory esophageal manometry: Comparison of expert and computer-aided manometry analyses. J Gastrointest Motil 2:216–223, 1990Google Scholar
- 10.Wiener GJ, Richter JE, Copper JB, Wu WC, Castell DO: The symptom-index: A clinically more important parameter of ambulatory 24-h esophageal pH monitoring. Am J Gastroenterol 83:358–361, 1988Google Scholar