SESSION TITLE: Clinical Improvement Posters
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM
PURPOSE: Gastroesophageal Reflux (GERD) is the third most common cause of chronic cough. Barium swallow study (BSS) is one of the most common tests ordered by clinicians when evaluating patients for GERD-induced cough. However, we know of no studies that explore the sensitivity or specificity of a BSS for diagnosis of GERD. We compared BSS to 24-hr esophageal pH/impedance probe monitoring to determine the sensitivity and specificity of BSS in diagnosing GERD.
METHODS: We retrospective review patients referred to our Cough Clinic from April 2012 to February 2013 for evaluation of possible GERD-induced cough. All patients had both BSS and 24-hr pH/impedance probe within a 48-hour time interval. All BSS were performed by a GI radiologist using a standard protocol, and were reported as either positive or negative for radiographic evidence of GERD. Patients then underwent fluoroscopic placement of an esophageal pH/impedance probe followed by monitoring for 24 hr. Any of the following findings from the 24-hr pH/impedance probe was considered abnormal and diagnostic for GERD: total number of reflux >73, number of acid reflux >55, number of non-acid reflux >27, pH<4 in distal esophagus >5.3% of the time, and/or Johnson/DeMeester score >22. We then calculate sensitivity, specificity, PPV and NPV of BSS, compared to data from 24-hr pH impedance studies.
RESULTS: A total of 44 patients had both BSS and 24-hr pH/impedance studies. There were 3 false positive, 14 true negative, 17 false negative and 10 true positive BSS. Sensitivity of BSS for predicting GERD was 37.0%, with a specificity of 82.4%, PPV 76.9%, and NPV 45.2%.
CONCLUSIONS: When compared to a 24-hr pH/impedance probe study, BSS has a poor sensitivity for diagnosing GERD in patients with cough. However, it is highly specific; when positive, it may be very helpful in confirming the diagnoses of GERD. A negative BSS does not rule out pathological GERD in patients with chronic cough.
CLINICAL IMPLICATIONS: Physicians should not rule out GERD as a cause of chronic cough in patients with a negative BSS.
DISCLOSURE: The following authors have nothing to disclose: Scott Kopec, Jingli Ma, Joseph Ferrucci
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