Johnson LF, DeMeester TR. Development of the 24-hour intraesophageal pH monitoring composite scoring system. J Clin Gastroenterol 1986; 8(Suppl 1):52-58.

Авторы: Johnson L.F. / DeMeester T.R.

Development of 24-hour Intraesophageal pH Monitoring Composite Scoring System

Lawrence F. Johnson and *Tom R. DeMeester

From the Department of Medicine, Gastroenterology Service, Walter Reed Army Medical Center, Washington, DC; and Depart­ament of Medicine, Digestive Diseases Division, Uniformed Services University of the Health Sciences, Bethesda, Maryland, U.S.A.
* Present address: Department of Surgery, Creighton University, Omaha, NE 68131, U.S.A



We describe in detail our logic for deriving a system to score 24-hour intraesophageal pH records of patients with gastro esophageal reflux. This system uses a uniform scoring unit and pH monitoring parameters taken from both the day and nighttime segments of the pH record. The score quantitates the degree of departure that a patient's reflux pattern exceeds physiologic reflux found in asymptomatic control volunteers, and directly correlates with the degree of reactive epithelial change characteristic of reflux esophagitis. Even though the scoring system was derived over 11 years ago, its logic and scoring principles are consistent with new concepts that con­ cern the pathophysiology of gastroesophageal reflux disease.

Physiologic reflux in an asymptomatic subject. This portion of the pH record shows LES competence during sleep and four episodes of reflux after breakfast.²

While 24-h intraesophageal pH monitoring provided the desired goal of objectively measuring the marker of gastroesophageal reflux disease, i.e., reflux of acid gastric contents into the distal esophagus, the technique presented a complex problem as to how to define or score that objectivity. The 24-h pH composite score, developed to address this issue¹, has been briefly described in both oral presentations and published reports, but program time limits and journal space restrictions have prevented a detailed description of the logic involved in its derivation. This journal supplement on reflux esophagitis, published approximately 11 years after the publication of our composite score, provides an opportunity to reexamine the logic and merits of the score, especially in light of recent advances in our understanding of the pathophysiology of gastro­esophageal reflux disease. It is our expectation that this communication will foster the concept of scoring 24-h pH records, as well as inspire others to address this important issue.

См. далее в новом окне (формат pdf, 1,87 Mb): Johnson LF, DeMeester TR. Development of 24-hour intraesophageal pH monitoring composite scoring system (1986).


¹ Johnson LF, DeMeester TR. Twenty-four-hour pH Monitoring of the Distal Esophagus: A Quantitative Measure of Gastroesophageal Reflux. The American Journal of Gastroenterology. Volume 62, Issue 4, October 1974, P.325-332.
² График «Физиологические рефлюксы утром у бессимптомного пациента» получен на аппаратуре для 24-часовой рН-метрии, изображённой на фотографии: «24-часовая рН-метрия пищевода в Армейском медицинском центре имени Триплера (англ. Tripler Army Medical Center), в Гонолулу, Гавайи, США».

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См. также: Johnson LF, DeMeester TR. Development of 24-hour intraesophageal pH monitoring composite scoring system. Esophageal Disorders: Pathophysiology and Therapy / Ed. by TR DeMeester and DB Skinner, NY: Raven Press; 1985. P. 561-70.

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