Inter‐ and Intraobserver Agreement in 24‐hour Combined Multiple Intraluminal Impedance and pH Measurement in Children

Abstract

Most measurements showed substantial to perfect intra- and interobserver agreement. Still, we found a few outliers presumably caused by poorer signal quality in some tracings rather than being observer dependent. An improvement of analysis results may be achieved by using a standard analysis protocol, a standardized method for judging tracing quality, better training options for method users, and more interaction between investigators from different institutions.

Impedance pH Monitoring: Intra-observer and Inter-observer Agreement and Usefulness of a Rapid Analysis of Symptom Reflux Association

“…It is not easy to compare previous reports with ours because those studies considered all reflux episodes together, i.e., without separating acid and non-acid reflux, and data were presented in different formats. Regarding inter-observer agreement, the 2 observers in the study by Pilic et al 9 had an agreement which varied widely among the 24 tracings, from 0 to 98% with a median of 73%, whereas the 2 observers in the study by Zerbib et al 11 had an overall agreement of 84% off PPIs and 73% on PPIs. Our results, obtained analyzing 40 tracings, showed lower inter-observer agreement on number of non-acid compared to acid reflux episodes (48.9-81.5% vs. 86.3-97.6%).…”

“…17 Our study investigated also intra-and inter-observer agreements on number of acid and non-acid reflux episodes. Previous studies have addressed this topic in the paediatric 8,9 and in the adult healthy 11 and GERD population, 10 although the 2 latter studies looked at inter-observer agreement only. Furthermore in the paper by Ravi et al 10 analysis was limited to classifying trac-ings with either normal or pathological number of reflux episodes.…”

“…Both a quantitative (i.e., number of reflux episodes) and a qualitative analysis (i.e., symptom reflux association) should be performed, the latter analysis having a higher relevance in PPI refractory patients who frequently have a normal number of reflux episodes. 2,3 Studies on intra-and inter-observer agreement of manual analysis are scanty, small, referred to the paediatric population or to healthy adults, [8][9][10][11] and they have focused on number of reflux episodes only.…”

Evaluation of the Accuracy of Computer Automated Analysis of Esophageal 24- hour Impedance pH Studies

“…Data from previous MII-pH studies has demonstrated that non-acid reflux accounts for at least half of reflux episodes, and bears a strong correlation with symptoms. The capabilities of MII-pH testing have been recognized, with many studies comparing the results with pH monitoring exclusively, especially for evaluation of the temporal connection between GER and symptoms [11][12][13][14].…”

Ösophageale Refluxdiagnostik – pH-Metrie, Impedanzmessung, Bilirubin-Messung: Empfehlungen der Deutschen Gesellschaft für Neurogastroenterologie und Motilität und der Arbeitsgruppe Neurogastroenterologie der Deutschen Gesellschaft für Verdauungs- und Stoffwechselkrankheiten

“…Eine automatisierte Auswertung ist sensitiv, jedoch nicht spezifisch, sodass eine manuelle Kontrolle nach entsprechender Einarbeitung erforderlich ist. Dieser Aspekt wurde bei aktuellen Untersuchungen untermauert [308,309]. Normative Werten wurden anhand von Untersuchungen an gesunden Probanden ermittelt [310].…”