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Accuracy of the water‐siphon test associated to barium study in a high prevalence gastro‐oesophageal reflux disease population: a novel statistical approach
Author(s) -
Fiorentino Eugenio,
Matranga Domenica,
Pantuso Gianni,
Cabibi Daniela,
Bonventre Sebastiano,
Barbiera Filippo
Publication year - 2010
Publication title -
journal of evaluation in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.737
H-Index - 73
eISSN - 1365-2753
pISSN - 1356-1294
DOI - 10.1111/j.1365-2753.2009.01158.x
Subject(s) - medicine , reflux , endoscopy , confidence interval , gastroenterology , gastro , gold standard (test) , population , disease , surgery , environmental health
Summary Rationale, aims and objectives Gastro‐oesophageal reflux disease (GORD) is ‘a condition which develops when the reflux of gastric content causes troublesome symptoms or complications’. Instrumental diagnostic tests generally used for GORD are 24‐hour pH‐metry and upper gastrointestinal (GI) endoscopy but barium study associated with provocative manoeuvres such as the water‐siphon test (WST), has also been used for GORD. The aim of this paper was to estimate the accuracy of several tests in patients with GORD in a tertiary care setting, focusing on WST, which is rapid and non‐invasive, simple to perform and well‐tolerated by patients. Method A total of 172 consecutive patients, symptomatic for reflux referred to a tertiary medical centre, were considered and data regarding the WST, 24‐hour pH‐metry, upper GI endoscopy with histology were analysed using latent class analysis, a multivariable statistical method for estimating the accuracy of tests when a gold standard is not available. Results The overall proportion of GORD in the sample was estimated at 0.664 [95% confidence interval (CI) = (0.589; 0.731)]. WST proved to be the most sensitive [Se = 0.886; 95% CI = (0.688; 1.000)] compared with pH‐metry [Se = 0.620; 95% CI = (0.493; 0.745)] and endoscopy with histology [Se = 0.534; 95% CI = (0.273; 0.789)]. It was less specific [Sp = 0.537; 95% CI = (0.003; 1.000)] than pH‐metry [Sp = 0.547; 95% CI = (0.281; 0.813)], and even less than endoscopy with histology [Sp = 0.862; 95% CI = (0.495; 1.00)]. Positive predictive values were estimated at 0.792 [95% CI = (0.721; 0.862)] for WST, 0.731 [95% CI = (0.643; 0.819)] for pH‐metry and 0.886 [95% CI = (0.811; 0.961)] for endoscopy with histology. Negative predictive values were estimated at 0.707 [95% CI = (0.573; 0.841)] for WST, 0.422 [95% CI = (0.310; 0.534)] for pH‐metry and 0.484 [95% CI = (0.387; 0.581)] for endoscopy with histology. Conclusion Water‐siphon test might possibly be useful in patients with suspected GORD because it is highly sensitive and predictive. A positive outcome of the WST associated with a barium study can certainly justify upper GI endoscopy and support any pharmacological treatment of GORD.