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Symptom reports are not reliable during ambulatory reflux monitoring

A study in December's American Journal of Gastroenterology finds that symptom reports are not reliable during ambulatory reflux monitoring.

News image

Patient reporting of symptom events during ambulatory reflux monitoring is commonly performed with little data regarding its accuracy.

Dr Robert Kavitt and colleagues employed a novel time-synchronized ambulatory audio recording of symptom events simultaneously with prolonged pH/impedance monitoring to assess temporal accuracy of patient-reported symptoms.

The team used an acoustic monitoring system to detect cough events via tracheal and chest wall sounds, and it was temporally synchronized with an ambulatory impedance/pH monitoring system.

Patients were instructed to record their symptoms in the usual manner.

The docotors noted that 6 separate observers independently listened to the 24-hour audio recordings, and logged the exact timing of each cough event.

Patients were blinded to study design and the audio reviewers were blinded to their own reports and those of patients and other reviewers.

Patients did not report 91% of audible cough events based on 1-minute 
American Journal of Gastroenterology

Concurrence of audio recordings and patient-reported symptoms were tested for 3 separate time thresholds, including 1, 2, and 5 minutes.
 
The research team found that the median number of cough events by audio detection was significantly higher than those reported by patients: 216 and 34, respectively.

There was significantly higher agreement among the audio recording listeners than between the audio recording and patient-reported symptoms.

Patients did not report 91%, 82%, and 71% of audible cough events based on 1-, 2-, and 5-minutes concordance time windows, respectively.

Dr Kavitt's team commented, "We found that patients do not report the majority of their symptoms during ambulatory reflux monitoring even within a 5-minutes time window of the true event and advise caution in clinical decision-making based solely on symptom indices."

Am J Gastroenterol 2012: 107(12): 18261832
14 December 2012

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