Limitations of Gold Standards for Diagnosing Gastroesophageal Reflux Disease
Authors: Kaveh G. Shojania
Journal: Annals of Internal Medicine (2004)

Letters19 October 2004Limitations of Gold Standards for Diagnosing Gastroesophageal Reflux DiseaseKaveh G. Shojania, MDKaveh G. Shojania, MDFrom University of Ottawa, Ottawa, Ontario K1Y 4E9, Canada.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-141-8-200410190-00019 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:The meta-analysis by Numans and colleagues (1), while well-designed in itself, suffers from limitations of the gold standards used to diagnose gastroesophageal reflux disease (GERD). Many patients with heartburn have normal findings at endoscopy. Conversely, results of esophageal pH monitoring fall within the normal range in a substantial minority of patients whose endoscopic findings indicate GERD. Moreover, both tests suffer from inter- and intraobserver variation (2-4). Similar limitations almost certainly apply to structured symptom questionnaires, which may even have poor specificity (5). Thus, the findings of Numans and colleagues (1) probably reveal more about the gold standards ...References1. Numans ME, Lau J, de Wit NJ, Bonis PA. Short-term treatment with proton-pump inhibitors as a test for gastroesophageal reflux disease: a meta-analysis of diagnostic test characteristics. Ann Intern Med. 2004;140:518-27. [PMID: 15068979] LinkGoogle Scholar2. Armstrong D, Bennett JR, Blum AL, Dent J, De Dombal FT, Galmiche JP, et al . The endoscopic assessment of esophagitis: a progress report on observer agreement. Gastroenterology. 1996;111:85-92. [PMID: 8698230] CrossrefMedlineGoogle Scholar3. Kusano M, Ino K, Yamada T, Kawamura O, Toki M, Ohwada T, et al . Interobserver and intraobserver variation in endoscopic assessment of GERD using the “Los Angeles” classification. Gastrointest Endosc. 1999;49:700-4. [PMID: 10343212] CrossrefMedlineGoogle Scholar4. Franzen T, Grahn LT. Reliability of 24-hour oesophageal pH monitoring under standardized conditions. Scand J Gastroenterol. 2002;37:6-8. [PMID: 11843037] CrossrefMedlineGoogle Scholar5. Carlsson R, Dent J, Bolling-Sternevald E, Johnsson F, Junghard O, Lauritsen K, et al . The usefulness of a structured questionnaire in the assessment of symptomatic gastroesophageal reflux disease. Scand J Gastroenterol. 1998;33:1023-9. [PMID: 9829354] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of Ottawa, Ottawa, Ontario K1Y 4E9, Canada. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoShort-Term Treatment with Proton-Pump Inhibitors as a Test for Gastroesophageal Reflux Disease Mattijs E. Numans , Joseph Lau , Niek J. de Wit , and Peter A. Bonis Limitations of Gold Standards for Diagnosing Gastroesophageal Reflux Disease Mattijs E. Numans , Peter A. Bonis , and Joseph Lau Metrics 19 October 2004Volume 141, Issue 8Page: 648KeywordsEndoscopyFallsGastroesophageal reflux diseaseProton pump inhibitorsQuestionnairesSpecificityStable coronary artery disease ePublished: 19 October 2004 Issue Published: 19 October 2004 CopyrightCopyright © 2004 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...