Wiener G J, Richter J E, Copper J B, Wu W C, Castell D O
Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina.
Am J Gastroenterol. 1988 Apr;83(4):358-61.
Ambulatory 24-h esophageal pH monitoring is an accurate quantitative test of gastroesophageal reflux (GER). However, it does not answer the question: are the patients' symptoms due to GER? We developed a numerical scale to quantify the percent association between symptoms and pH less than 4--the symptom index (SI). In 100 consecutive patients with heartburn or chest pain, the SI for the chief complaint was either high (greater than 75%) or low (less than 25%) in 77% of cases. A similar bimodal distribution was seen when heartburn or chest pain symptoms were individually evaluated. There was a good association between high SI and the presence of GER (97.5%), as well as low SI and a normal 24-h pH study (81.1%). Endoscopy was normal in 89.5% of patients with low SI, but patients with high SI had esophagitis in only 69.7% of cases. The Bernstein test showed a poor association with the SI. Therefore, the SI gives clinically relevant information regarding the role of acid reflux and patient's symptoms. We believe this simple calculated index should be included in the analysis of 24-h esophageal pH studies.
动态24小时食管pH监测是一种准确的胃食管反流（GER）定量检测方法。然而，它并不能回答这个问题：患者的症状是由GER引起的吗？我们制定了一个数字量表来量化症状与pH值小于4之间的关联百分比——症状指数（SI）。在100例连续的烧心或胸痛患者中，77%的病例中主要症状的SI要么高（大于75%）要么低（小于25%）。单独评估烧心或胸痛症状时也观察到类似的双峰分布。高SI与GER的存在之间存在良好关联（97.5%），低SI与24小时pH研究正常之间也存在良好关联（81.1%）。SI低的患者中89.5%的内镜检查正常，但SI高的患者中只有69.7%的病例有食管炎。伯恩斯坦试验与SI的关联较差。因此，SI提供了关于酸反流作用和患者症状的临床相关信息。我们认为这个简单的计算指数应该纳入24小时食管pH研究的分析中。
