title: Symptom association probability and symptom sensitivity index: preferable but still suboptimal predictors of response to high dose omeprazole.
abstract: BACKGROUND
  Twenty four hour oesophageal pH monitoring is frequently used to quantify the association between a patient's symptom and gastro-oesophageal reflux. Three indices (symptom association probability (SAP), symptom index (SI), and symptom sensitivity index (SSI)) are used to quantify and establish this relation.
  
  
  OBJECTIVE
  The aim of the present study was to compare these indices against the omeprazole test (OT) as an objective indicator of reflux induced symptoms.
  
  
  METHODS
  Fifty two patients with a predominant symptom of heartburn were enrolled from gastroenterology and primary care clinics. Baseline symptom score was calculated at the fist visit. All patients underwent 24 hour oesophageal pH monitoring, and symptom-reflux association indices were calculated. All patients were placed on high dose omeprazole (40 mg in the morning, 20 mg at night) after completion of pH monitoring and symptom score was recorded again after one week.
  
  
  RESULTS
  Thirty eight patients completed the study. All three indices were significantly related to each other (p<0.001). SAP and SSI (with a new cut off of 1.3, but not with the commonly used 5%) had statistically significant relations with OT (p<0.05 for both). SSI had the highest positive and negative predictive values and sensitivity. The specificity of SSI and SAP was equal and lower than SI. Areas under the receiver operating characteristic (ROC) curve for the three indices were not significantly different from each other or from a hypothetical non-discriminating test. Per cent time pH <4, sex, and age had no relation to OT and no effect on its correlation with association indices. No cut off point could be found at which the results of SI could be related significantly to the OT results.
  
  
  CONCLUSIONS
  SAP and SSI are significantly related to symptomatic response to high dose omeprazole; however, they are far from perfect, with a significant number of discordant cases as well as relatively small areas under the ROC curves. We suggest that the new cut off of 1.3 be used for SSI in the future. Further research is needed to identify possible methods to improve the discrimination power of these indices or to identify possible patient characteristics that may affect this relation.
authors.affiliation: Gastroenterohepatology Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran. ataghavi@sums.ac.ir
authors.forename: S A
authors.initials: SA
authors.lastname: Taghavi
authors.forename: M
authors.initials: M
authors.lastname: Ghasedi
authors.forename: M
authors.initials: M
authors.lastname: Saberi-Firoozi
authors.forename: M
authors.initials: M
authors.lastname: Alizadeh-Naeeni
authors.forename: K
authors.initials: K
authors.lastname: Bagheri-Lankarani
authors.forename: M J
authors.initials: MJ
authors.lastname: Kaviani
authors.forename: L
authors.initials: L
authors.lastname: Hamidpour
mesh_terms: D000328:Adult; D004334:Drug Administration Schedule; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D006356:Heartburn / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory / Q000379:methods; D009853:Omeprazole / Q000008:administration & dosage*; D011446:Prospective Studies; D054328:Proton Pump Inhibitors; D012372:ROC Curve; D012680:Sensitivity and Specificity
chemical_list: D054328:Proton Pump Inhibitors; D009853:Omeprazole