What does a low Symptom Index mean on a PH test?

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theacidrefluxman
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   Posted 1/24/2012 8:36 AM (GMT -6)   
This is another thing I need to ask my Dr. The highest symptom index I have ever had was 50%, and I have had as low as 18% (in terms of symptoms correlating to reflux events during a PH test).

Does anyone know what this means? I think it is one of the reasons the dr's don't take mine too seriously even though the symptoms are rough to deal with. Has anyone else had a low symptom index, and what were you told about it? Thanks!

dencha
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   Posted 1/24/2012 5:50 PM (GMT -6)   
Hi ARM,
I found this online:

Forty per cent of patients with heartburn may have no evidence of oesophagitis or of abnormal oesophageal acid exposure. The symptom index correlates symptoms that occur during pH monitoring with episodes of acid reflux, being the number of symptoms during reflux divided by the total number occurring during monitoring. This index was assessed in 61 patients with heartburn. In 39 patients with endoscopic evidence of oesophagitis or abnormal acid exposure times on pH monitoring, the symptom index had a sensitivity of 90 per cent. Of the 22 patients with no objective abnormality, the index was ≥ 50 per cent in five (23 per cent) whose symptoms were presumably due to acid reflux despite results of other investigations being normal, suggesting an acid-sensitive oesophagus. The symptom index is a useful additional measure in the investigation of patients with suspected gastro-oesophageal reflux disease.

Here's the URL for the study abstract:

http://onlinelibrary.wiley.com/doi/10.1002/bjs.1800791022/abstract

I believe it means the correlation between your button pushing/perceived heartburn episodes when having the actual 24hr PH monitoring and its relationship to actual reflux as measured by the probe or BRAVO capsule.  Hope that helps a little.

Good luck with your quest!

Denise

 

Post Edited (dencha) : 1/24/2012 5:08:03 PM (GMT-7)


theacidrefluxman
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Date Joined Oct 2009
Total Posts : 739
   Posted 1/24/2012 11:04 PM (GMT -6)   
Thanks Denise. I kind of had an idea, but thanks for the detail on your response. What I am really wondering is what it means...does it mean those with a low symptom index are potentially not suffering from acid reflux?

Do you know what I mean? In my mind it must have some diagnostic value, so that those that come back with a low symptom index like me are given a different treatment than those with a high symptom index. From what you wrote I guess it might not mean much....people with the same problem can have either low or high indexes...that is what I am understanding from that excerpt...

theacidrefluxman
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Date Joined Oct 2009
Total Posts : 739
   Posted 1/24/2012 11:15 PM (GMT -6)   
Just read it again...I guess they are saying it might mean sensitive esophagus. But I had read in other things that sensitive esophagus was diagnosed when there was a normal PH test and a positive symptom association (which intuitively makes sense)...not sure

dencha
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Date Joined Feb 2009
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   Posted 1/25/2012 7:53 AM (GMT -6)   
Hi ARM,
My guess is that when you have a low symptom index it might be a reason to hold off on surgery.  If someone is reacting to very little reflux, and surgery can't get reflux to zero, then perhaps the surgery won't help.  I always had a DeMeester (PH) score in the normal range.
 
I was one of those people whose symptoms or lack of them led my GI doc to drag his feet for years regarding surgery.
 
Persistence will pay off.  You know your body best.  Try to get some other docs on your side.  Pursue all options!
 
Good luck!
Denise

Post Edited (dencha) : 1/25/2012 5:57:06 AM (GMT-7)


theacidrefluxman
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Date Joined Oct 2009
Total Posts : 739
   Posted 1/25/2012 9:33 AM (GMT -6)   
Hey Denise,

You are a quick one :) You almost repeated verbatim what my most recent Dr. told me when you wrote "If someone is reacting to very little reflux, and surgery can't get reflux to zero, then perhaps the surgery won't help". He said that, and that if I get the surgery that he thinks I'll have the same symptoms and just have a few holes in my stomach for the effort. I was referred to him by Mayo clinic, and since my other docs have told me surgery isn't a good idea I feel like I have to take their word on it. As bad and constant as the symptoms are, even I am not stubborn enough to go against the advice of 3 doctors and the surgeons I have seen as well...

I just wonder what can be diagnosed with the way I have come out on tests. I mean, with all the tests I have done I wish they could just say "ok, its hypersensitive esophagus", or "ok, it is GERD". Next time I am going to ask my Dr. how close a diagnosis is, or if it is just impossible to be definitive on one, or what is the deal.

Thanks for your advice :)
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