J Neurogastroenterol Motil.
2018 Apr;24(2):233-240. 10.5056/jnm17077.
Juice Test for Identification of Nonerosive Reflux Disease in Heartburn Patients
- Affiliations
-
- 1Faculdade de Medicina, Universidade de Passo Fundo (UPF), Passo Fundo-RS, Brazil. FernandoFornari@gmail.com
- 2Departamento de EstatÃstica, Instituto de Matemática e EstatÃstica, Universidade Federal do Rio Grande do Sul, Porto Alegre-RS, Brazil.
- 3Programa de Pós-Graduação: Ciências em Gastroenterologia e Hepatologia, Universidade Federal do Rio Grande do Sul, Porto Alegre-RS, Brazil.
- 4Programa de Pós-Graduação em Odontologia da UPF, Passo Fundo-RS, Brazil.
- KMID: 2413099
- DOI: http://doi.org/10.5056/jnm17077
Abstract
- BACKGROUND/AIMS
Evaluation of esophageal clearance by orange juice swallowing could be useful to identify different categories of gastroesophageal reflux disease. We determined whether a juice test at the beginning of esophageal pH monitoring can identify nonerosive reflux disease (NERD) among heartburn patients.
METHODS
Multiple swallows of orange juice (pH 3) were performed at the beginning of esophageal pH monitoring in 71 heartburn patients off acid-suppressive therapy. The area between pH drop below 5 and recovery to 5 was calculated from pH tracings and named Delta5 (mmol·L−1·sec). Fifteen healthy subjects served to determine Delta5 cutoff (95th percentile). Patients were classified as NERD, non-NERD (a mix of reflux hypersensitivity, functional heartburn, and undetermined), and erosive disease depending on acid exposure, reflux symptom analysis, and upper endoscopy.
RESULTS
Delta5 cutoff in healthy subjects was 251 mmol·L−1·sec. Among 71 patients, 23 had NERD, 26 had non-NERD, and 22 had erosive disease. Compared to non-NERD, Delta5 was higher in both NERD (median [interquartile range]: 316 [213-472] vs 165 [105-225]; P < 0.01) and erosive disease (310 [169-625] vs 165 [105-225]; P < 0.01). An elevated Delta5 (> 251 mmol·L−1·sec) showed sensitivity of 74% and specificity of 81% for identification of NERD. Positive and negative likelihood ratios were 3.84 and 0.32 respectively, whereas test accuracy was 78%.
CONCLUSIONS
A juice test with calculation of Delta5 helps in the identification of true NERD among heartburn patients with endoscopy-negative reflux disease. In these patients, an elevated Delta5 could make prolonged reflux testing unnecessary.
