Specificity and sensitivity of objective diagnosis of gastroesophageal reflux disease.
Specificity and sensitivity of objective diagnosis of gastroesophageal reflux disease.
复制标题
胃食管反流病客观诊断的特异性和敏感性。
作者：
K. Fuchs;T. Demeester;M. Albertucci
为了评价不同试验对胃食管反流病的诊断价值，由45名有烧心和反流症状（伴或不伴食管炎）的患者和45名从未经历过烧心、反流或吞咽不适的健康受试者组成了一个试验人群。受试人群接受食管镜检查、标准酸反流试验、24小时pH监测和下食管括约肌测压。计算敏感性、特异性、阳性预测值、阴性预测值以及测试和测试组合的准确性。食管镜检查的敏感性为62%，也就是说，只有62%的患者在内镜检查中有粘膜损伤的证据。食管下括约肌测压的敏感性为84%，特异性为89%，准确性为87%。24小时食管pH监测的敏感性、特异性和准确性为96%。结果表明，24小时pH监测可以通过测量食管酸暴露的增加来检测胃食管反流病，准确率为96%。食管下括约肌测压可以检测出机械性括约肌缺陷作为疾病的原因，准确率为87%。24小时监测和运动研究的测试组合可以选择由于贲门缺陷而导致食管暴露于胃液增加的患者，准确率为91%。抗反流手术旨在通过在贲门处建立机械抗反流机制，减少括约肌缺陷患者的食管暴露于胃液。因此，有必要在手术前用测压法确定括约肌的机械状态。因此，抗反流手术的适应症是（1）食管暴露于胃液的增加的不受控制的症状;（2）通过24小时pH监测记录的食管暴露于胃液的增加;和（3）括约肌动力性机械缺陷，压力≤ 6 mm Hg，总长度≤ 2 cm，腹部长度≤ 1 cm。
To evaluate the diagnostic value of different tests for gastroesophageal reflux disease, a test population was constructed from 45 patients with symptoms of heartburn and regurgitation with or without esophagitis and 45 healthy subjects, who never experienced heartburn, regurgitation, or swallowing discomfort. The test population underwent esophagoscopy, standard acid reflux test, 24-hour pH monitoring, and manometry of the lower esophageal sphincter. Sensitivity, specificity, positive predictive value, negative predictive value, and the accuracy of the tests and test combinations were calculated. Esophagoscopy had a sensitivity of 62%, that is, only 62% of patients with the disease have evidence of mucosal damage on endoscopy. Manometric measurements of the lower esophageal sphincter had a sensitivity of 84%, a specificity of 89%, and an accuracy of 87%. Twenty-four hour esophageal pH monitoring had a sensitivity, specificity, and accuracy of 96%. The results show that 24-hour pH monitoring can detect gastroesophageal reflux disease with an accuracy of 96% by measuring an increase in esophageal acid exposure. Manometry of the lower esophageal sphincter can detect a mechanically deficient sphincter as a cause of the disease with an accuracy of 87%. The test combination of 24-hour monitoring and motility studies can select patients with an accuracy of 91% who have an increase in esophageal exposure to gastric juice because of a deficient cardia. Antireflux surgery is designed to reduce esophageal exposure to gastric juice in patients with a deficient sphincter by creating a mechanical antireflux mechanism at the cardia. Therefore it is necessary to determine the mechanical status of the sphincter with manometry before surgery in such patients. Thus the indications for antireflux surgery are (1) uncontrolled symptoms of increased esophageal exposure to gastric juice; (2) a documented increase in esophageal exposure to gastric juice by 24-hour pH monitoring; and (3) a mechanically defective sphincter on motility with a pressure of 6 mm Hg or less, an overall length of 2 cm or less, and an abdominal length of 1 cm or less.