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

Background: Esophageal pH monitoring in conjunction with multichannel intraluminal impedance (MII-pH) is now considered the most accurate method for detection and characterization of gastro-esophageal reflux (GER), with higher sensitivity and specificity in detecting reflux than esophageal pH monitoring alone. Aims: One possibly limiting factor for using MII-pH testing is the time required to analyze the results. Automatic interpretation softwares have been produced to reduce this, in this study, we assessed the reliability of two 24 hour MII-pH analysis softwares compared to the interpretation provided by an expert. Methods: We performed a retrospective review of 200 MII-pH studies done on patients with reflux symptoms between September 2009 and September 2014. The studies were split into two groups of 100 patients: one group’s testing was performed using MMS equipment and software, and the other group used Sandhill Scientific equipment and software. All tracings were additionally analyzed by an expert and the interpretations were compared. Results: Our data indicated a strong correlation between the expert’s analysis and both automatic softwares in all positions, Demeester score, reflux episodes and symptoms index (p<0.0001). For studies interpreted as either normal or abnormal, there was concordance between the expert analysis and the software 95% of the time for the MMS software, and 93% of the instances for the Sandhill software. Conclusions: The MII-pH data analysis software provide reliable diagnostic utility and are time-efficient at the present time, but it is advisable to seek interpretation from an experienced interpreting physician, prior to signing off the report in order to avert any possible troubles such as probe malfunctioning.