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Objective definition and detection of transient lower esophageal sphincter relaxation revisited: is there room for improvement?

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dc.contributor.authorHolloway, R.
dc.contributor.authorBoeckxstaens, G.
dc.contributor.authorPenagini, R.
dc.contributor.authorSifrm, D.
dc.contributor.authorSmout, A.
dc.date.issued2012
dc.description.abstractBackground  The advent of drugs that inhibit transient lower esophageal sphincter relaxation (TLESR) necessitates accurate identification and scoring. We assessed the intra- and inter-assessor variability of the existing objective criteria for TLESR, improving them where necessary. Methods  Two 3-h postprandial esophageal manometric and pH recordings were performed in 20 healthy volunteers. Each recording was duplicated. The recordings were analyzed by five experienced observers for TLESRs based on their expert opinion. TLESRs were also analyzed for the presence of the original four criteria as well as inhibition of the crural diaphragm (ID), a prominent after-contraction (AC), acid reflux and an esophageal common cavity. Key Results  The overall inter- and intra-observer agreements for TLESRs scored, according to observer’s expert opinion, were 59% (range 56–67%) and 74% (60–89%), respectively. When TLESRs were restricted to those fulfilling the original criteria, these agreements fell to 46% (40–53%) and 60% (44–67%), respectively. Cleaning the recordings by removal of technically flawed sections improved agreements by 5%. Inclusion of additional criteria (ID and AC) resulted in inter- and intra-observer agreements of 62% (52–70%) and 69% (53–79%), respectively. A consensus analysis performed collectively by three observers and based on the new criteria (original ± ID and AC) resulted in 84% agreement between the paired recordings. Conclusions & Inferences  The original criteria for the definition of TLESRs allows for substantial inter- and intra-observer variability, which can be reduced by incorporation of additional objective criteria. However, the highest level of intra-observer agreement can be achieved by consensus analysis.
dc.description.statementofresponsibilityR. H. Holloway, G. E. E. Boeckxstaens, R. Penagini, D. A. Sifrm, & A. J. P. M. Smout
dc.identifier.citationNeurogastroenterology and Motility, 2012; 24(1):54-60
dc.identifier.doi10.1111/j.1365-2982.2011.01812.x
dc.identifier.issn1350-1925
dc.identifier.issn1365-2982
dc.identifier.urihttp://hdl.handle.net/2440/70367
dc.language.isoen
dc.publisherBlackwell Publishing Ltd
dc.rights© 2011 Blackwell Publishing Ltd.
dc.source.urihttps://doi.org/10.1111/j.1365-2982.2011.01812.x
dc.subjectesophageal manometry
dc.subjectgastroesophageal reflux
dc.subjectlower esophageal sphincter.
dc.titleObjective definition and detection of transient lower esophageal sphincter relaxation revisited: is there room for improvement?
dc.typeJournal article
pubs.publication-statusPublished

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